UNIT #2

Question 1

The DSM-IV classifies substance-related disorders into two major categories:

Answer 1

substance use disorders and substance-induced disorders.

Question 2

substance-induced disorders

Answer 2

Disorders, such as intoxication, that can be induced by using psychoactive substances

Question 3

Substance use disorders

Answer 3

are patterns of maladaptive use of psychoactive substances. These disorders, which include substance abuse and substance dependence

Question 4

substance abuse

(5)

Answer 4

(1) is a pattern of recurrent use that leads to damaging consequences.
(2) Damaging consequences may involve failure to meet one’s major role responsibilities (e.g., as student, worker, or parent), (3) putting oneself in situations where substance use is physically dangerous (e.g., mixing driving and substance use), (4) encountering repeated problems with the law arising from substance use (e.g., multiple arrests for substance-related behavior), or
(5) having recurring social or interpersonal problems because of substance use (e.g., repeatedly getting into fights when drinking

Question 5

substance dependence

(3)

Answer 5

(1) Substance abuse continues for a long period of time or progresses
(2) a more severe disorder associated with physiological signs of dependence (tolerance or withdrawal syndrome) or compulsive use of a substance.
(3) People who become compulsive users lack control over their drug use. They may be aware of how their drug use is disrupting their lives or damaging their health, but feel helpless or powerless to stop using drugs, even though they may want to.

Question 6

Diagnostic Features of Substance Dependence

(7)

Answer 6

(1) Tolerance for the substance
(2) Withdrawal symptoms
(3) Taking larger amounts of the substance or for longer periods of time than the individual intended
(4) Persistent desire to cut down or control intake of substance or lack of success in trying to exercise self-control.
(5) Spending a good deal of time in activities directed toward obtaining the substance
(6) The individual has reduced or given up important social, occupational, or recreational activities due to substance use
(7) Substance use is continued despite evidence of persistent or recurrent psychological or physical problems either caused or exacerbated by its use

Question 7

Tolerance

Answer 7

is a state of physical habituation to a drug, resulting from frequent use, such that higher doses are needed to achieve the same effect.

Question 8

withdrawal syndrome (also called an abstinence syndrome)

(3)

Answer 8

(1) is a cluster of symptoms that occur when a dependent person abruptly stops using a particular substance following heavy, prolonged use.
(2) People who experience a withdrawal syndrome often return to using the substance to relieve the discomfort associated with withdrawal, which thus serves to maintain the addictive pattern.
(3) Withdrawal symptoms vary with the particular type of drug.

Question 9

addiction

(3)

Answer 9

(1) is compulsive use of a drug accompanied by signs of physiological dependence.
(2) People become compulsive users when they have impaired control over their use of a drug.
(3) In effect, they feel compelled to continue using the drug despite the negative consequences that continued use of the drug entails.

Question 10

physiological dependence. (2)

Answer 10

(1) A condition in which the drug user’s body comes to depend on a steady supply of the substance.
(2) The major signs of physiological dependence are the development of tolerance and a withdrawal syndrome.

Question 11

psychological dependence

Answer 11

Compulsive use of a substance to meet a psychological need

Question 12

Although the progression to substance dependence varies from person to person, one common pathway involves a progression through the following stages:

(2)

Answer 12

(1) Experimentation
(2) Routine use

Question 13

Experimentation

Answer 13

(1) the drug temporarily makes users feel good, even euphoric.
(2) Users feel in control and believe they can stop at any time.

Question 14

Routine Use

(4)

Answer 14

(1) people begin to structure their lives around the pursuit and use of drugs.
(2) Denial plays a major role at this stage, as users mask the negative consequences of their behavior to themselves and others.
(3) Values change.
(4) What had formerly been important, such as family and work, comes to matter less than the drugs.

Question 15

Drugs of abuse are generally classified within three major groupings:

Answer 15

(a) depressants, such as alcohol and opioids; (b) stimulants, such as amphetamines and cocaine; and (c) hallucinogens

Question 16

depressant

(2)

Answer 16

(1) is a drug that slows down or curbs the activity of the central nervous system.
(2) It reduces feelings of tension and anxiety, slows movement, and impairs cognitive processes.

Question 17

Risk Factors for Alcoholism

(5)

Answer 17

(1) gender
(2) age
(3) antisocial personality disorder
(4) family history
(5) Sociodemographic factors

Question 18

barbiturates

Answer 18

Sedative drugs which are depressants with high addictive potential

Question 19

narcotics

Answer 19

Drugs that are used medically for pain relief but that have strong addictive potential.

Question 20

stimulants

Answer 20

Psychoactive substances that increase the activity of the nervous system.

Question 21

amphetamines

Answer 21

A class of stimulants that activate the central nervous system, producing heightened states of arousal and feelings of pleasure.

Question 22

major theoretical perspectives on substance abuse and dependence

(5)

Answer 22

(1) Biological Perspectives
- Neurotransmitters
- genetic factors
(2) Learning Perspectives
- Operant Conditioning
- Alcohol and Tension Reduction
- Negative Reinforcement and Withdrawal
- The Conditioning Model of Cravings
- Observational Learning
(3) Cognitive Perspectives
(4) Psychodynamic Perspectives
(5) Sociocultural Perspectives

Question 23

Neurotransmitters

(4)

Answer 23

(1) Many psychoactive drugs, including nicotine, alcohol, heroin, marijuana, and especially cocaine and amphetamines, increase levels of the neuro-transmitter dopamine in the brain’s pleasure or reward circuits—the networks of neurons responsible for producing feelings of pleasure or states of euphoria
(2) Consequently, the brain’s natural reward system—the “feel good” circuitry that produces states of pleasure associated with the ordinarily rewarding activities of life,—becomes blunted
(3) the addict’s brain comes to depend on having the drug available to produce feelings of pleasure or satisfaction
(4) Endorphins and opiates dock at the same receptor sites in the brain. Normally, the brain produces a certain level of endorphins that maintains a psychological steady state of comfort and potential to experience pleasure. However, when the body becomes habituated to a supply of opioids, it may stop producing endorphins. This makes the user dependent on opiates for comfort, relief from pain, and pleasure.

Question 24

Biological perspectives (2)

Answer 24

(1) focuses on uncovering the biological pathways that may explain mechanisms of physiological dependence.
(2) spawns the disease model, which posits that alcoholism and other forms of substance dependence are disease processes.

Question 25

Genetic factors (2)

Answer 25

(1) Evidence links genetic factors to various forms of substance use
(2) Alcoholism tends to run in families). The closer the genetic relationship, the greater the risk.

Question 26

Learning Perspectives (4)

Answer 26

(1) substance-related behaviors are largely learned and can, in principle, be unlearned
(2) Substance abuse problems are not regarded as symptoms of disease but rather as problem habits.
(3) they emphasize the role of learning in the development and maintenance of these problem behaviors.
(4) Drug use may become habitual because of the pleasure (positive reinforcement) or temporary relief (negative reinforcement) from negative emotions, such as anxiety and depression, which drugs can produce

Question 27

Examples of learning perspectives (2)

Answer 27

(1) Operant & classical Conditioning
(2) observational learning

Question 28

Operant Conditioning (3)

Answer 28

(1) learn that the drug can produce reinforcing effects, such as feelings of euphoria, and reductions in anxiety and tension.
(2) can thus be reinforcing when it is used to combat depression (by producing euphoric feelings, even if short lived), to combat tension, or to help people sidestep moral conflicts (for example, by dulling awareness of moral prohibitions).
(3) Substance abuse may also provide social reinforcers, such as the approval of drug-abusing companions and, in the cases of alcohol and stimulants, the (temporary) overcoming of social shyness.

Question 29

tension-reduction theory

Answer 29

the more often one drinks to reduce tension or anxiety, the stronger or more habitual the habit becomes.

Question 30

Negative Reinforcement and Withdrawal (operant conditioning) (3)

Answer 30

(1) Once people become physiologically dependent, negative reinforcement comes into play in maintaining the drug habit.
(2) people may resume using drugs to gain relief from unpleasant withdrawal symptoms.
(3) In operant conditioning terms, relief from unpleasant withdrawal symptoms is a negative reinforcer for resuming drug use

Question 31

The Conditioning Model of Cravings (Classical conditioning) (5)

Answer 31

(1) may help explain drug cravings.
(2) In this view, cravings reflect the body’s need to restore high blood levels of the addictive substance and thus have a biological basis.
(3) also come to be associated with environmental cues associated with prior use of the substance.
(4) These cues, such as the sight or aroma of an alcoholic beverage or the sight of a needle and syringe, become conditioned stimuli that elicit a conditioned response: strong cravings for the drug.
(5) Sensations of anxiety or depression that are paired with the use of alcohol or drugs may also elicit cravings.

Question 32

Observational Learning (2)

Answer 32

(1) Modelling or observational learning plays an important role in determining risk of substance abuse problems.
(2) Parents who model inappropriate or excessive drinking or use of illicit drugs may set the stage for maladaptive drug use in their children

Question 33

Cognitive Perspectives

(3)

Answer 33

(1) focus on roles of attitudes, beliefs, and expectancies in accounting for substance use and abuse.
(2) Expectancies about the perceived benefits of using alcohol or other drugs and smoking cigarettes clearly influence the decision to use these substances.
(3) Alcohol or other drug use may also boost self-efficacy expectations—personal expectancies we hold about our ability to successfully perform tasks. If we believe we need a drink or two (or more) to “get out of our shell” and relate socially to others, we may come to depend on alcohol in social situations.

Question 34

treatment has often been a frustrating endeavour (2)

Answer 34

(1) Treatment takes place in a setting—such as the therapist’s office, a support group, a residential center, or a hospital—in which abstinence is valued and encouraged. Then the individual returns to the work, family, or street settings in which abuse and dependence were instigated and maintained. The problem of relapse can thus be more troublesome than the problems involved in initial treatment.
(2) many people with substance abuse problems have other psychological disorders as well. However, most clinics and treatment programs focus on the drug or alcohol problem, or the other psychological disorders, rather than treating all these problems simultaneously. This narrow focus results in poorer treatment outcomes, including more frequent rehospitalizations among those with these dual diagnoses.

Question 35

detoxification

Answer 35

The process of ridding the system of alcohol or other drugs under supervised conditions.

Question 36

Disulfiram

Answer 36

discourages alcohol consumption because the combination of the two produces a violent response consisting of nausea, headache, heart palpitations, and vomiting

Question 37

methadone

Answer 37

An artificial narcotic that is used to help people who are addicted to heroin to abstain from it without a withdrawal syndrome.

Question 38

Culturally sensitive treatment

Answer 38

addresses all aspects of the person, including ethnic factors and the nurturance of pride in one’s cultural identity. Ethnic pride may help people resist the temptation to cope with stress through alcohol and other substances

Question 39

Residential Approaches to treatment

Answer 39

treatment requires a stay in a hospital or therapeutic residence. Hospitalization is recommended when substance abusers cannot exercise self-control in their usual environments, cannot tolerate withdrawal symptoms, or behave self-destructively or dangerously.

Question 40

Psychodynamic Approaches to treatment (2)

Answer 40

(1) Psychoanalysts view substance abuse and dependence as symptoms of conflicts rooted in childhood experiences.
(2) The therapist attempts to resolve the underlying conflicts, assuming that abusive behavior will then subside as the client seeks more mature forms of gratification.

Question 41

Behavioral approaches to treating substance abuse and dependence (2)

Answer 41

(1) focus on modifying abusive and dependent behavior patterns.
(2) The key question to behaviorally oriented therapists is not whether substance abuse and dependence are diseases but whether abusers can learn to change their behavior when they are faced with temptation.

Question 42

Self-Control Strategies for Modifying the “ABCs” of Substance Abuse

(3)

Answer 42

(1) Controlling the As (Antecedents) of Substance Abuse
(2) Controlling the Bs (Behaviors) of Substance Abuse
(3) Controlling the Cs (Consequences) of Substance Abuse

Question 43

Controlling the As (Antecedents) of Substance Abuse

(6)

Answer 43

(1) People who abuse or become dependent on psychoactive substances become conditioned to a wide range of external (environmental) and
internal stimuli (bodily states). They may begin to break these stimulus-response connections by:
(2) Removing drinking and smoking paraphernalia from the home—including all alcoholic beverages, beer mugs, carafes, ashtrays, matches,
cigarette packs, lighters, etc.
(3) Restricting the stimulus environment in which drinking or smoking is permitted by using, the substance only in a stimulus-deprived area of
their homes, such as the garage, bathroom, or basement. All stimuli that might be connected to using the substance are removed from this
area—e.g., there is no TV, reading materials, radio, or telephone. In this way, substance abuse becomes detached from many controlling
stimuli.
(4) Not socializing with others with substance abuse problems, by avoiding situations linked to abuse—bars, the street, bowling alleys, etc.
(5) Frequenting substance-free environments—lectures or concerts, a gym, museums, evening classes; and by socializing with nonabusers,
eating in restaurants without liquor licenses.
(6) Managing the internal triggers for abuse. This can be done by practicing self-relaxation or meditation and not taking the substance when
tense; by expressing angry feelings by writing them down or self-assertion, not by taking the substance; by seeking counseling not alcohol,
pills, or cigarettes, for prolonged feelings of depression.

Question 44

Controlling the Bs (Behaviors) of Substance Abuse

(4)

Answer 44

(1) People can prevent and interrupt substance abuse by:
(2) Using response prevention—breaking abusive habits by physically preventing them from occurring or making them more difficult (e.g., by
not bringing alcohol home or keeping cigarettes in the car).
(3) Using competing responses when tempted; by being prepared to handle substance-related situations with appropriate ammunition—mints,
sugarless chewing gum, etc.; by taking a bath or shower, walking the dog, walking around the block, taking a drive, calling a friend, spending
time in a substance-free environment, practicing meditation or relaxation, or exercising when tempted, rather than using the substance.
(4) Making abuse more laborious—buying one can of beer at a time; storing matches, ashtrays, and cigarettes far apart; wrapping cigarettes in
foil to make smoking more cumbersome; pausing for 10 minutes when struck by the urge to drink, smoke, or use another substance and
asking oneself, “Do I really need this one?”

Question 45

Controlling the Cs (Consequences) of Substance Abuse

(6)

Answer 45

(1) Substance abuse has immediate positive consequences such as pleasure, relief from anxiety and withdrawal symptoms, and stimulation.
People can counter these intrinsic rewards and alter the balance of power in favor of nonabuse by:
(2) Rewarding themselves for nonabuse and punishing themselves for abuse.
(3) Switching to brands of beer and cigarettes they don’t like.
(4) Setting gradual substance-reduction schedules and rewarding themselves for sticking to them.
(5) Punishing themselves for failing to meet substance-reduction goals. People with substance abuse problems can assess themselves,
say, 10 cents for each slip and donate the cash to an unpalatable cause, such as a brother-in-law’s birthday present.
(6) Rehearsing motivating thoughts or self-statements—such as writing reasons for quitting smoking on index cards.

Question 46

Contingency Management Programs

(3)

Answer 46

(1) our behavior is shaped by rewards and punishments.
(2) programs provide reinforcements (rewards)
contingent on performing desirable behaviors, such as producing drug-negative urine samples.
(3) Investigators are finding that even modest rewards for abstinence can help improve therapeutic outcomes in treating substance abusers.

Question 47

Aversive Conditioning (3)

Answer 47

(1) painful or aversive stimuli are paired with substance abuse or abuse-related stimuli to condition a negative emotional response to drug-related stimuli.
(2) effects are often temporary and fail to generalize to
real-life settings in which aversive stimuli are no longer administered.
(3) However, it may be useful as a treatment component in a broader-based treatment program.

Question 48

Social Skills Training (2)

Answer 48

(1) helps people develop effective interpersonal
responses in social situations that prompt substance abuse.
(2) Evidence suggests that social skills training are useful in treating alcoholism

Question 49

Relapse-Prevention Training

(4)

Answer 49

(1) Between 50% to 90% of people who are successfully treated for substance abuse problems eventually relapse.
(2) Because of the prevalence of relapse, cognitive-behavioral therapists have devised a number of methods referred to as relapse-prevention training.
(3) This training is designed to help substance abusers identify high-risk situations and learn effective coping for handling these situations without turning to alcohol or drugs.
(4) Participants in relapse prevention training programs learn to view lapses as temporary setbacks that provide opportunities to learn what kinds of situations lead to temptation and to either avoid them or learn to cope with them.

Question 50

Sociocultural perspectives

Answer 50

emphasize the cultural, group, and social factors that underlie drug-use patterns, including the role of peer pressure in determining adolescent drug use.

Question 51

Psychodynamic theorists

Answer 51

view problems of substance abuse, such as excessive drinking and habitual smoking, as signs of an oral fixation.

Question 52

Specific skills that are appropriate with crisis intervention include:

(6)

Answer 52

(1) using minimal encouragements,
(2) paraphrasing,
(3) emotion labeling, and
(4) mirroring,
(5) open-ended questioning,
(6) “I” messages, and pauses

Question 53

more specific explanation from the Ottawa Police Service’s Mental Health Unit about when and where you have the authority to apprehend for the purpose of a mental health examination without an accompanying “Form”. If an individual:

(6)

Answer 53

1. has threatened or attempted or is threatening or attempting to cause bodily harm to himself or herself;
2. has behaved or is behaving violently towards another person or has caused or is causing another person to fear bodily harm from him or her;
3. or has shown or is showing a lack of competence to care for himself or herself, and in addition the police officer is of the opinion that the person is apparently suffering from mental disorder of a nature or quality that likely will result in,
4. serious bodily harm to the person;
5. serious bodily harm to another person; or
6. Serious physical impairment of the person, and that it would be dangerous to proceed under section 16(Form 2), the police officer may take the person in custody to an appropriate place for examination by a physician

Question 54

Form 1 - Form 1 – Authority

(3)

Answer 54

(1) is completed by a physician and can be completed within 7 days of having seen that patient.
(2) It gives authority to anyone (including police) to bring an individual in for a psychiatric assessment;
(3) this Form results in an involuntary hold that is valid for up to 72 hours, after which time the appropriate psychiatric staff will either admit voluntarily or involuntarily to a psychiatric facility or release this individual following assessment

Question 55

Form 2 – Order for Examination

(4)

Answer 55

(1) is an order from a Justice of the Peace which authorizes police officers to bring in an individual in to a physician so that the physician can determine whether or not a further psychiatric assessment is necessary
(2) should this be the case, that physician could complete a Form 1.
(3) When bringing individuals in under a Form 2, it is most common for police to bring individuals to the hospital for an evaluation, however a physician’s office could also be an option.
(4) The police officer bringing an individual in custody to a psychiatric facility must remain until the facility has accepted custody

Question 56

Form 9 - Order for Return

(4)

Answer 56

(1) can be issued by an officer responsible for a psychiatric facility;
(2) are enacted when a patient has been absent from a facility but is required to be detained without leave.
(3) have to be issued within 1 month of a patient’s absence;
(4) this authorizes police officers to return this patient to the appropriate psychiatric facility

Question 57

Form 47- Order for Examination, Under a Community Treatment Order (CTO)

(3)

Answer 57

(1) can be issued when an individual violates the terms/conditions of their CTO (CTO’s are valid for 6 months unless renewed or terminated before the 6 months).
(2) permits officers with the authority to apprehend an individual in violation of their CTO.
(3) Rather than bring the individual to a hospital for a psychiatric examination, officers are required to bring the individual to the Physician who has ordered the Form 47

Question 58

According to Ruiz and Miller (2004), some of the following circumstances can potentially lead to increased physical confrontations between police officers and PMI’s:

(5)

Answer 58

(1) If there is a perception of danger (often a result of stigma), officers may be more inclined to try and rush to a resolution without engaging in effective de-escalation
(2) Fear (on the PMI’s part) due to the officer’s uniform or the overpowering “take control” demeanor of officers
(3) Fear of the officers (on the PMI’s part) because they (the officers) are unfamiliar
(4) Hesitance of PMI to comply with officers order (a possible outcome of their illness and capacity)
(5) A lack of understanding and empathy from officers

Question 59

crisis intervention is not just about “taking control”

Answer 59

rather it involves effective communication

Question 60

Specific skills that are appropriate with crisis intervention include:

(7)

Answer 60

(1) using minimal encouragements,
(2) paraphrasing,
(3) emotion labeling, and
(4) mirroring,
(5) open-ended questioning,
(6) “I” messages, and
(7) pauses.

Question 61

Minimal Encouragements:

(2)

Answer 61

(1) these are timely yet minimal and brief replies to show the individual that you are listening an attending to them (e.g., phrases like yes, OK, and I see).
(2) These types of responses can help to encourage the individual to remain engaged and provides time for you as the officer to gain more control over the interaction

Question 62

Paraphrasing:

(3)

Answer 62

(1) this involves summarizing what you’ve heard the other person say;
(2) this gives the individual an opportunity to correct your interpretation if you are incorrect, and
(3) otherwise it also shows the individual you are listening

Question 63

Emotion Labelling:

(6)

Answer 63

(1) Those in crisis or PMI’s are often reactive to their feelings.
(2) It is not uncommon for people to think “I feel … therefore it is true”.
(3) However, we know that just because someone feels something, this does not make it a reality.
(4) With that said, when someone “feels” something strongly, it is important to acknowledge and validate their feeling – after all if we know what someone is feeling we can help them manage and cope more effectively – you wouldn’t cope with depression and anger in the same way so it is important to parse this out.
(5) if you’re incorrect about their emotion, this gives the individual an opportunity to correct you, and you can build from there.
(6) If you are correct, it validates them, makes them feel “heard” and provides you with an opportunity to engage in a conversation trying to instill a sense of hope or possibility

Question 64

Mirroring:

(3)

Answer 64

(1) In a crisis situation this can involve repeating the last sets of words that an individual has just spoke to you;
(2) validates that they are feeling heard, but provides you with an opportunity to build rapport.
(3) This establishes a non-confrontational stance and provides you with an opportunity to gain more insight and information into the individual in question

Question 65

Open-ended Questions:

(2)

Answer 65

(1) These provide you with an opportunity to get more information without asking “why” – why can make people feel as though they are being interrogated, which is not conducive to effective conversation.
(2) An open-ended question is essentially one that cannot result in a “yes” or “no” response

Question 66

“I” messages/statements

(2)

Answer 66

(1) These enable you to effectively communicate your stance in an interaction – “I feel ….. when you…/that we….. and as a result
(2) Be mindful with this tool as to not get engaged in an argument with the individual in question – this is merely a tool for you to be able to express yourself and let the individual know that their actions have implications on you as much as your actions do to them

Question 67

Pauses:

(3)

Answer 67

(1) If used appropriately, pauses are a great tool to slow down an interaction, or provide an individual with more time to speak (people often feel uncomfortable with silence and so they may provide more information to fill the quiet gap).
(2) This in turn again provides you with more information regarding this individual and their status;
(3) it can also re-assure the individual in question that they still have some “control” – even it is perceived

Question 68

with interacting with PMI’s or those who may be under the influence, it is also important to inquire about medications; According to Hoffman and Putnam (2004), the following questions are relevant and pertinent to your work:

(8)

Answer 68

(1) Are you on any medication?
(2) Do you take pills?
(3) May I see the vials?
(4) Are you taking them as your doctor ordered?
(5) When did you last take your pills?
(6) How many?
(7) When did you last take your medication?
(8) May I take these vials with us to show the doctor? (If you are escorting to a hospital)

Question 69

Should you challenge delusional thinking when interacting with PMI?

Answer 69

People who are delusional don’t know that their thinking is flawed; as such it is important for you to NOT challenge them because this could lead to further agitation, mistrust or increased stress on the part of the PMI, which can then increase the delusional thinking they are experiencing.

Question 70

If you recognize that an individual is hallucinating, strategies you should implement are: (11)

Answer 70

(1) Isolate the individual and contain
(2) Respect personal space (do not touch or stand too close without permission)
(3) Speak clearly and slowly using simple language
(4) Ask questions like: “are you hearing other voices or seeing other things in the room other than me?”, “can you tell me a bit about what these voices are telling you?”, “what do you see, feel, taste, smell?”
(5) Calmly instruct: “try to listen to my voice and not the other voices that you’re hearing”
(6) Explain your actions and try to reduce distractions (e.g., bright lights, TV, radio)
(7) Address this person by their name and if you do not know it, politely ask
(8) Do not pretend to see, hear, feel, smell, taste the things they claim to be experiencing
(9) Be mindful that increased stress may increase hallucinations
(10) Try and remain calm yourself and know that you are responsible for grounding their reality.
(11) Validate their feelings but still let them know that you do not see, feel, hear, smell or taste what they claim to be

Question 71

If you recognize that an individual is exhibiting delusional thinking, strategies you should implement are: (7)

Answer 71

(1) Isolate and contain
(2) Try and keep your distance; if space is an issue, try and keep something between you and the individual (e.g., a piece of furniture)
(3) Respect personal space (do not touch or stand too close without permission)
(4) Avoid whispering or humour as this may be misunderstood
(5) Explain your actions and try to reduce distractions (e.g., bright lights, TV, radio)
(6) Ask questions like: “Are you having any thoughts that are disturbing/upsetting you or others?”
(7) Do not try and convince them that their thinking is not real

Question 72

Because delusion of persecution are some of the most common which police come in contact with it is also important to consider the following: (3)

Answer 72

(1) Do not show or state that you believe the delusion, rather explain and validate their perspective without refuting their thoughts or agreeing with them
(2) Ask if there are things that could be done to make them more comfortable
(3) Assure them that they are safe and that the weapons you carry are to keep them safe and not to harm them

Question 73

If you recognize that an individual is exhibiting major depression, strategies you should implement are: (4)

Answer 73

(1) Do not try to cheer the person up by using humour – this is a default move by many people when interacting with someone who is depressed (often because we feel uncomfortable being around someone who is so low).
(2) Instead, validate their feelings, and let them know that you are there to help and support them (e.g., “I can see that you’re in a lot of pain, and that is why I am here… I’m here to help”).
(3) Be patient and try to convey hope that with the right supports their mood can improve and that is does not always have to be like this.
(4) If actively suicidal or homicidal escort to appropriate mental health services

Question 74

If you recognize that an individual is discussing and exhibiting suicide ideation, strategies you should implement are: (5)

Answer 74

(1) Ask questions, being clear and direct to determine whether or not they have an active plan and/or means to carry out this plan (are they planning on ending their life, what would they do, when would they do it, what means do they have or how would they obtain them).
(2) Remember asking about suicide will not “put the idea” into their mind.
(3) If they answer “yes” to ANY of the above, do not leave them alone
(4) You would also want to asses if they have had past attempts (when and by what means), and discuss whether or not they’ve been hospitalized for an attempt or ideation in the past.
(5) This will help you get more information to assess risk

Question 75

If you recognize that an individual is exhibiting mania, strategies you should implement are: (5)

Answer 75

(1) Explain your actions and try to reduce distractions (e.g., bright lights, TV, radio)
(2) Isolate and contain if possible
(3) Allow for pacing and movement
(4) Be brief and direct with your questioning; do not have lengthy conversations
(5) Determine if they can care for themselves in this state or if they have a supportive person

Question 76

If you recognize that an individual is exhibiting symptoms of panic, strategies you should implement are:

Answer 76

(1) Encourage slowed breath to facilitate calming – even do this with them if it will help them focus and calm down
(2) Do not use the words “calm down”
(3) Be short and simple with your discussions and assure they are safe
(4) Let them know that you will and can take control if needed
(5) Explain your actions and try to reduce distractions or noise
(6) Refer or escort to a crisis service if necessary

Question 77

Excited Delirium (2)

Answer 77

(1) is a disorder that could lead to death;
(2) onset is typically associated with illicit drug use, alcohol abuse and/or failure to take prescribed antipsychotic medications properly

Question 78

Excited Delirium recognition of symptoms (15)

Answer 78

(1) Bizarre and/or aggressive behaviour,
(2) disorientation,
(3) acute onset of paranoia,
(4) panic,
(5) shouting,
(6) violence towards others,
(7) hallucinations,
(8) impaired thinking,
(9) unexpected physical strength,
(10) apparent ineffectiveness of pepper spray,
(11) significantly diminished sense of pain,
(12) sweating,
(13) fever,
(14) heat intolerance,
(15) sudden tranquility after frenzied activity

Question 79

If you’re concerned someone is experiencing delirium because the risk of spontaneous death it is imperative you:

Answer 79

call an ambulance to have them escorted to hospital.

Question 80

Regarding excited delirium, If you must transport in a police vehicle:

Answer 80

ensure two officers are present for safety and proper restraint and monitoring can occur

Question 81

Regarding an individual with excited delirium what should be considered when transporting and restraining?

Answer 81

Avoid transporting this individual in a face down position and recognize that certain restraints should not be used

Question 82

General Guidelines when Interacting with PMIs: DOs

(13)

Answer 82

(1) collect as much information as possible from all possible sources prior to intervening
(2) do take your time & eliminate noise and distractions, i.e., television, radio, bright lights
(3) do ask permission first
(4) do treat with dignity and respect as you would want a family member to be treated
(5) do keep your distance and respect personal space
(6) do talk slowly and quietly
(7) identify yourself and others and explain your intentions/actions
(8) your actions should be slow and prior warning should be given if you intend on moving about the room
(9) do explain in a firm but gentle voice that you want to help.
(10) Ask how you can be of assistance
(11) do develop a sense of working together “help me to understand what is happening to you”
(12) do if they are fearful of your equipment, take the time to explain that you carry the equipment to enable you to perform your job which is to protect the public and them
(13) do give choices whenever possible to allow some level of control

Question 83

General Guidelines when Interacting with PMIs: DONTs

(6)

Answer 83

(1) do not deceive — be honest and open in all situations — you are reality
(2) do not challenge
(3) do not tease or belittle
(4) do not forget the pain and fear s/he is experiencing — remember emtoions can be painful
(5) do not violate personal space
(6) do not forget to ask about medications that are being used

Question 84

Considerations for Police when dealing with PMI’s

(8)

Answer 84

1. Disengage
2. Unconditional release
3. Release to families/friends
4. Convince to voluntarily admit self
5. Consult with mental health professional
6. Apprehend under MHA (S. 17/Form 7)
7. Information (S. 16)
8. Arrest

Question 85

Considerations for Police when dealing with PMI’s: Disengage

Open to? ONLY IF? HOPEFULLY LEADING TO? (2) Special condition? (4)

Answer 85

Open to: anyone

Only if: the situation is or can be contained (i.e., no danger to self or others)

Hopefully leading to? - re-assessment for back-up, etc.
- consider other use of force options

Special condition: - take your time!

• remove distractions
• avoid excitement
• continue to contain until special response unit or back-up arrive

Question 86

Considerations for Police when dealing with PMI’s: Unconditional release

Open to? ONLY IF? (4) HOPEFULLY LEADING TO? (1) Special condition? (2)

Answer 86

Open to: P.O

Only if: - minor incident

• mental diorder is not incapacitating
• person is calm
• reasonably certain no reoccurrence

Hopefully leading to: - no reoccurrence

Special Condition: - document all interactions/referrals
- enter on SIP/FIP

Question 87

Considerations for Police when dealing with PMI’s: Release to families/friends

Open to? ONLY IF? (2) HOPEFULLY LEADING TO? (1) Special condition? (1)

Answer 87

Open to? P.O

ONLY IF? - believe incident would reoccur
- releasing on own would be unsafe

HOPEFULLY LEADING TO? having family/friends assume responsibility

Special condition? document all interactions/referrals

Question 88

Considerations for Police when dealing with PMI’s: Convince to voluntarily admit self

Open to? (2) ONLY IF? (1) HOPEFULLY LEADING TO? (1) Special condition? (1)

Answer 88

Open to? P.O, Anyone else

ONLY IF? it is possible (this may be the only option when there is no available care-taker and does not fit criteria for apprehension)

HOPEFULLY LEADING TO? voluntary admission

Special condition? document all interactions/referrals

Question 89

Considerations for Police when dealing with PMI’s: Consult with mental health professional

Open to? (2) ONLY IF? (2) HOPEFULLY LEADING TO? (2) Special condition? (3)

Answer 89

Open to? P.O, anyone else

ONLY IF? - one is available
- the incident falls between unconditional release and apprehension

HOPEFULLY LEADING TO? - additional information
- choice of appropriate disposition

Special condition? - telephone

• on-scene
• central location

Question 90

Considerations for Police when dealing with PMI’s: Apprehend under MHA (S. 17/Form 7)

Open to? (1) ONLY IF? (3) HOPEFULLY LEADING TO? (1) Special condition? (2)

Answer 90

Open to? P.O.

ONLY IF? - R&PG a person acting in a disorderly manner

• you believe is due to a mental disorder and you have reasonable cause to believe the person is a danger to self or others
• dangerous to wait

HOPEFULLY LEADING TO? - admission information Physician’s order (form #1 detains a person for up to 72 ours in a psychiatric facility).

Special condition? - custody to be transferred as soon as reasonably possible
- police officer be notified promptly when decision is made to accept or not accept custody of a person by the psyciatric facility

Question 91

Considerations for Police when dealing with PMI’s: Information (S. 16)

Open to? (1) ONLY IF? (1) HOPEFULLY LEADING TO? (1) Special condition? (2)

Answer 91

Open to? Anyone

ONLY IF? when waiting would not be dangerous, must convince J.P.

HOPEFULLY LEADING TO? J.P.’s order (form #2 for apprehension and transport to a psychiatric facility for assessment)

Special condition? - valid for only 7 days after signing
- apprehension is made by P.O. in that jurisdiction

Question 92

Considerations for Police when dealing with PMI’s: Arrest

Open to? (1) ONLY IF? (1) HOPEFULLY LEADING TO? (1) Special condition? (1)

Answer 92

Open to? Anyone

ONLY IF? an offence has been committed

HOPEFULLY LEADING TO? judge’s order (consult with Crown)

Special condition? notify lock-up staff and jail staff