understanding mental illness a review of the disorders

55
Understanding Mental Understanding Mental Illness Illness A Review of the Disorders A Review of the Disorders

Upload: linda-reese

Post on 30-Dec-2015

36 views

Category:

Documents


6 download

DESCRIPTION

Understanding Mental Illness A Review of the Disorders. Defining Mental Illness. Clinical definition : Clinically significant behavioral problems Associated with distress (painful symptoms) Causes disability (impairment in functioning) A biological illness that responds to treatment - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Understanding Mental Illness  A Review of the Disorders

Understanding Mental Illness Understanding Mental Illness A Review of the DisordersA Review of the Disorders

Page 2: Understanding Mental Illness  A Review of the Disorders

Defining Mental IllnessDefining Mental Illness

Clinical definition :Clinical definition :

• Clinically significant behavioral problemsClinically significant behavioral problems

• Associated with distress (painful symptoms) Associated with distress (painful symptoms)

• Causes Causes disability (impairment in functioning)disability (impairment in functioning)• A biological illness that responds to treatmentA biological illness that responds to treatment

• Not to be confused with weakness of characterNot to be confused with weakness of character

Page 3: Understanding Mental Illness  A Review of the Disorders

Facts about Mental IllnessFacts about Mental Illness

Has nothing to do with Has nothing to do with intelligenceintelligence

Can happen to anyoneCan happen to anyone Chronic but not contagiousChronic but not contagious Difficult to diagnose and Difficult to diagnose and

to treatto treat Treated but not curedTreated but not cured

Mentally ill are not all Mentally ill are not all dangerousdangerous

Should not be confused Should not be confused with terms psychopath or with terms psychopath or sociopathsociopath

Page 4: Understanding Mental Illness  A Review of the Disorders

General Signs of Mental IllnessGeneral Signs of Mental Illness

• ObservableObservable• ConfusionConfusion• DisorientedDisoriented• Darting looks Darting looks • Talking to selfTalking to self• Poverty of SpeechPoverty of Speech• Pressured speechPressured speech• Poor hygienePoor hygiene• Inappropriate attireInappropriate attire

• Behavior Changes Behavior Changes • Flat Affect Flat Affect • WithdrawnWithdrawn• Sad or anxious moodSad or anxious mood• PanicPanic• Psycho somatic complaintsPsycho somatic complaints

Page 5: Understanding Mental Illness  A Review of the Disorders

SchizophreniaSchizophreniaSymptomsSymptoms• Brain disease Brain disease • Includes psychosisIncludes psychosis• Impacts 1 out of every 100 people. Does Impacts 1 out of every 100 people. Does

not differentiate across SESnot differentiate across SES• Onset is late teens, early adulthood.Onset is late teens, early adulthood.• Positive Symptoms include :Positive Symptoms include :

– hallucinationshallucinations– delusional thinkingdelusional thinking

• Negative symptoms includeNegative symptoms include– apathy apathy – withdrawal.withdrawal.

Page 6: Understanding Mental Illness  A Review of the Disorders

SchizophreniaSchizophrenia

Symptoms in JailSymptoms in Jail May appear non compliantMay appear non compliant Agitated by voices and delusions -may look and act dangerousAgitated by voices and delusions -may look and act dangerous Command hallucinations may actually be dangerous Command hallucinations may actually be dangerous More likely to respond to clear directions, and reassurance in a More likely to respond to clear directions, and reassurance in a

kind tone of voicekind tone of voice Poor hygiene - Not aware of their surroundings enough to know Poor hygiene - Not aware of their surroundings enough to know

that they are not cleanthat they are not clean

Page 7: Understanding Mental Illness  A Review of the Disorders

Mood DisordersMood DisordersMajor DepressionMajor Depression

SymptomsSymptoms• Affects 5 percent of the general populationAffects 5 percent of the general population• Sad mood that lasts 2 weeksSad mood that lasts 2 weeks• Loss of interest or pleasure in daily activitiesLoss of interest or pleasure in daily activities• Changes in sleep, appetite, decreased energyChanges in sleep, appetite, decreased energy• Thought problems affect concentration, memory, decisions, Thought problems affect concentration, memory, decisions,

feelings of guilt, worthlessnessfeelings of guilt, worthlessness• Risk of suicide is highRisk of suicide is high• Important to differentiate mental health from Important to differentiate mental health from

physical problemsphysical problems• Responds well to treatmentResponds well to treatment

Page 8: Understanding Mental Illness  A Review of the Disorders

Mood DisordersMood DisordersMajor DepressionMajor Depression

Symptoms in JailSymptoms in JailLoss of interest in food and self careLoss of interest in food and self careMay not care about legal situationMay not care about legal situationSuicide risk is real and must be monitoredSuicide risk is real and must be monitoredRisk of suicide may increase after medicationRisk of suicide may increase after medication

Page 9: Understanding Mental Illness  A Review of the Disorders

Mood DisordersMood DisordersMania/ Bipolar DisorderMania/ Bipolar Disorder

SymptomsSymptoms Euphoric Mood (elevated, high or happy)Euphoric Mood (elevated, high or happy) Irritable Mood (touchy)Irritable Mood (touchy) Three Stages of Mania Hypomania, Acute Mania, PsychosisThree Stages of Mania Hypomania, Acute Mania, Psychosis

Bipolar Disorder - mood swings from depression Bipolar Disorder - mood swings from depression to maniato mania

Can be Rapid CyclingCan be Rapid Cycling

Page 10: Understanding Mental Illness  A Review of the Disorders

Mood DisordersMood DisordersMania/ Bipolar DisorderMania/ Bipolar Disorder

Symptoms in jailSymptoms in jailJail may be the consequence of the disorderJail may be the consequence of the disorderMood can swing from entertaining to hostileMood can swing from entertaining to hostileTalkativeness can be irritating Talkativeness can be irritating If depressed, often cry, feel hopeless, become suicidalIf depressed, often cry, feel hopeless, become suicidalCan be restless, pacing, demanding and destructiveCan be restless, pacing, demanding and destructiveOften non-compliantOften non-compliantCan be professional and well-educatedCan be professional and well-educated

Page 11: Understanding Mental Illness  A Review of the Disorders

Anxiety DisordersAnxiety DisordersPanic DisordersPanic Disorders

SymptomsSymptoms Prevalence is 1 to 2 percent of the population; Women twice as high as men.Prevalence is 1 to 2 percent of the population; Women twice as high as men. Panic attacks occur without warningPanic attacks occur without warning Symptoms include intense fear, heart palpitations,chest pain,Symptoms include intense fear, heart palpitations,chest pain,

shortness of breath, dizzinessshortness of breath, dizziness Person is concerned that the attacks will strike againPerson is concerned that the attacks will strike again

Symptoms in JailSymptoms in Jail Jail environment and structure of holding canJail environment and structure of holding can

induce symptomsinduce symptoms Referral is indicatedReferral is indicated

Page 12: Understanding Mental Illness  A Review of the Disorders

Anxiety DisordersAnxiety DisordersObsessive-Compulsive DisorderObsessive-Compulsive Disorder

SymptomsSymptoms ObsessionsObsessions are recurrent thoughts, images, impulses that cause are recurrent thoughts, images, impulses that cause

anxiety. They are illogical,at times repulsive and/or center on anxiety. They are illogical,at times repulsive and/or center on violence or harm.violence or harm.

Compulsions Compulsions are behaviors that are repetitive - attempts at reducing are behaviors that are repetitive - attempts at reducing the anxiety created by the obsessions.the anxiety created by the obsessions.

Symptoms in JailSymptoms in Jail Rarely seen in jail and do not pose high riskRarely seen in jail and do not pose high risk

Page 13: Understanding Mental Illness  A Review of the Disorders

Post Traumatic Stress DisorderPost Traumatic Stress Disorder

SymptomsSymptoms Exposure to an extremely stressful event.Exposure to an extremely stressful event. Painful memories, nightmares,, suspicion, anxiety, depression, feelings Painful memories, nightmares,, suspicion, anxiety, depression, feelings

of guilt and sleep difficultiesof guilt and sleep difficulties Symptoms worsen with exposure to similar eventsSymptoms worsen with exposure to similar events Substance abuse is a common method to copeSubstance abuse is a common method to cope

Symptoms in JailSymptoms in Jail Jail environment can trigger symptoms Jail environment can trigger symptoms Jail inmates and personnel can trigger symptomsJail inmates and personnel can trigger symptoms Lack of privacy and loss of control are issuesLack of privacy and loss of control are issues

Page 14: Understanding Mental Illness  A Review of the Disorders

PersonalityPersonality DisordersDisorders Inflexible, maladaptive, Inflexible, maladaptive,

ways of coping and relating ways of coping and relating Difficulty in holding steady Difficulty in holding steady

work and relationshipswork and relationships Difficult to changeDifficult to change Can co -exist with other Can co -exist with other

mental illnessesmental illnesses Behavior problemsBehavior problems

precipitate jailprecipitate jail

AntisocialAntisocial NarcissisticNarcissistic BorderlineBorderline AvoidantAvoidant ParanoidParanoid DependentDependent SchizotypalSchizotypal SchizoidSchizoid

Page 15: Understanding Mental Illness  A Review of the Disorders

Personality DisordersPersonality Disorders Predominant disorders in jail are Predominant disorders in jail are

Antisocial and BorderlineAntisocial and Borderline Jail environment heightens symptomsJail environment heightens symptoms Effective management requires Effective management requires

consistent limit-settingconsistent limit-setting Suicidal risk is real and must be Suicidal risk is real and must be

monitoredmonitored Jail personnel must professionally Jail personnel must professionally

manage housing unit, inmates and manage housing unit, inmates and themselvesthemselves

Page 16: Understanding Mental Illness  A Review of the Disorders

Substance AbuseSubstance Abuse

SymptomsSymptoms 85% of jail population have substance abuse problems 85% of jail population have substance abuse problems High correlation of substance abuse and other mental illnessesHigh correlation of substance abuse and other mental illnesses

Symptoms in JailSymptoms in Jail

• Monitor risk of OD or withdrawalMonitor risk of OD or withdrawal

• Monitor abuse of prescription drugsMonitor abuse of prescription drugs

• Can mimic other Mental illnessesCan mimic other Mental illnesses

• Long term abuse can cause dementiaLong term abuse can cause dementia

Page 17: Understanding Mental Illness  A Review of the Disorders

Co-occurring DisordersCo-occurring Disorders

Presence of both a mental illness and substance abuse disorderPresence of both a mental illness and substance abuse disorder High prevalence ratesHigh prevalence rates 60% of persons with a mood disorder also have a substance abuse 60% of persons with a mood disorder also have a substance abuse

disorderdisorder 50% of persons with schizophrenia also have a substance abuse 50% of persons with schizophrenia also have a substance abuse

disorderdisorder

In Jail - More prone to violence, impulsivity, paranoia and anxietyIn Jail - More prone to violence, impulsivity, paranoia and anxiety

Page 18: Understanding Mental Illness  A Review of the Disorders

Common Factors of Mental Illness and Common Factors of Mental Illness and Substance AbuseSubstance Abuse

Brain disordersBrain disordersLack of InsightLack of InsightChronicChronicImpacts FamilyImpacts FamilyShame and guiltShame and guiltNeeds TreatmentNeeds Treatment

Page 19: Understanding Mental Illness  A Review of the Disorders

Dementia and other Cognitive DisordersDementia and other Cognitive Disorders

SymptomsSymptoms• Memory problemsMemory problems• ConfabulationsConfabulations• Impaired thinkingImpaired thinking• Impaired JudgementImpaired Judgement

Symptoms in JailSymptoms in Jail• Poor memory and may not follow directionsPoor memory and may not follow directions• Treat individual as you would any with aTreat individual as you would any with a disabilitydisability

Page 20: Understanding Mental Illness  A Review of the Disorders

Mental RetardationMental Retardation

SymptomsSymptoms Poor adaptive functioning from birthPoor adaptive functioning from birth Related to intelligence, not thoughts, feelings and Related to intelligence, not thoughts, feelings and

behaviorsbehaviors

Symptoms in JailSymptoms in Jail Not to be confused with mental illnessNot to be confused with mental illness Requires patienceRequires patience

Page 21: Understanding Mental Illness  A Review of the Disorders

Effective CommunicationEffective Communication

Page 22: Understanding Mental Illness  A Review of the Disorders

Keys to CommunicationKeys to Communication

EmpathyEmpathy

WarmthWarmth

GenuineGenuine

Page 23: Understanding Mental Illness  A Review of the Disorders

Promoting CommunicationPromoting Communication

Listening:attend to both Listening:attend to both verbal and nonverbal cues, verbal and nonverbal cues, hear and observe, and hear and observe, and avoid distractionsavoid distractions

Clarification: Clarification: Restate.Repeat, Clarify, Restate.Repeat, Clarify, QuestionQuestion

Dealing with SilenceDealing with Silence

Respond EffectivelyRespond Effectively Maintain Personal SpaceMaintain Personal Space Open ended questionsOpen ended questions Non verbal CuesNon verbal Cues

Page 24: Understanding Mental Illness  A Review of the Disorders

Basic Communication GuidelinesBasic Communication Guidelines

Short, clear direct sentencesShort, clear direct sentencesSimple contentSimple content

Low stimulation levelLow stimulation levelDon’t force communicationDon’t force communicationBe consistentBe consistentDon’t take actions or reactions personallyDon’t take actions or reactions personally

Page 25: Understanding Mental Illness  A Review of the Disorders

Basic Communication GuidelinesBasic Communication Guidelines

Be patientBe patientPerson may not “get” all the Person may not “get” all the informationinformationBe pleasant and firmBe pleasant and firmPraise cooperative behaviorPraise cooperative behaviorPractice reflective listeningPractice reflective listeningKnow your non verbal communicationKnow your non verbal communication

Page 26: Understanding Mental Illness  A Review of the Disorders

Basic Communication GuidelinesBasic Communication Guidelines Short, clear direct sentencesShort, clear direct sentences Simple contentSimple content Low stimulation levelLow stimulation level Don’t force communication Don’t force communication

if person is withdrawnif person is withdrawn Be consistentBe consistent Don’t take actions or Don’t take actions or

reactions personallyreactions personally

Person may not “get” all the Person may not “get” all the information you provideinformation you provide

Be patientBe patient Be pleasant and firmBe pleasant and firm Praise cooperative behaviorPraise cooperative behavior Practice reflective listeningPractice reflective listening Know your non verbal Know your non verbal

communicationcommunication

Page 27: Understanding Mental Illness  A Review of the Disorders

Types of Non-Verbal Types of Non-Verbal CommunicationCommunication

Body PostureBody PostureFacial ExpressionFacial ExpressionEye ContactEye ContactGesturesGestures

Page 28: Understanding Mental Illness  A Review of the Disorders

Crisis ManagementCrisis Management

Page 29: Understanding Mental Illness  A Review of the Disorders

Crisis ManagementCrisis Management

Crisis definedCrisis defined

What is crisis interventionWhat is crisis intervention

Recognizing a person inRecognizing a person in

crisis – behavioralcrisis – behavioral

and verbal cuesand verbal cues

Page 30: Understanding Mental Illness  A Review of the Disorders

ViolenceViolence

The incidence of violence The incidence of violence is no greater in persons is no greater in persons with mental illness than it with mental illness than it is in the general populationis in the general population

Incidence increases 60% if Incidence increases 60% if the illness is untreated.the illness is untreated.

Substance use greatly Substance use greatly increases violence increases violence

Greatest risk, males in late Greatest risk, males in late teens to early 20’steens to early 20’s

Past behavior best Past behavior best predictorpredictor

Page 31: Understanding Mental Illness  A Review of the Disorders

Warning SignsWarning Signs

TremorsTremors Hyperactivity Hyperactivity Rigid PostureRigid Posture Clenched jaws and fistsClenched jaws and fists Pulsing arteriesPulsing arteries Verbal abuse/profanityVerbal abuse/profanity

Page 32: Understanding Mental Illness  A Review of the Disorders

Effective Crisis InterventionEffective Crisis Intervention Reduce StressReduce Stress

Force as the last resortForce as the last resort

Consider the symptoms of mental illnessConsider the symptoms of mental illness

Identify precipitating factorsIdentify precipitating factors

Goal is to de-escalateGoal is to de-escalate

Page 33: Understanding Mental Illness  A Review of the Disorders

5 Stages of Successful Interventions5 Stages of Successful Interventions

Immediacy- Intervene as Immediacy- Intervene as soon as possible. Goal is to soon as possible. Goal is to reduce anxiety.reduce anxiety.

Assume Control - via Assume Control - via providing the structure the providing the structure the person needs, not be person needs, not be overwhelming themoverwhelming them

Assess the situation- let the Assess the situation- let the person talk, watch for person talk, watch for nonverbal cues, be a guide nonverbal cues, be a guide and avoid judgements and and avoid judgements and putdownsputdowns

Situation ManagementSituation Management Post crisis interventionPost crisis intervention

Page 34: Understanding Mental Illness  A Review of the Disorders

5 Stages of Successful Interventions5 Stages of Successful Interventions

Immediacy- Intervene as Immediacy- Intervene as soon as possible. Goal is to soon as possible. Goal is to reduce anxiety.reduce anxiety.

Assume Control - via Assume Control - via providing the structure the providing the structure the person needs, not be person needs, not be overwhelming themoverwhelming them

Assess the situation- let the Assess the situation- let the person talk, watch for person talk, watch for nonverbal cues, be a guide nonverbal cues, be a guide and avoid judgements and and avoid judgements and putdownsputdowns

Situation ManagementSituation Management Post crisis interventionPost crisis intervention

Page 35: Understanding Mental Illness  A Review of the Disorders

Suicide and Suicide PreventionSuicide and Suicide Prevention

Page 36: Understanding Mental Illness  A Review of the Disorders

Jail suicide is 9 times higher than Jail suicide is 9 times higher than general pop.general pop.

8 of 10 have given prior warnings8 of 10 have given prior warningsAmbivalent about deathAmbivalent about deathAmbivalence is not the same as Ambivalence is not the same as

manipulationmanipulationMost jail suicides are not impulsiveMost jail suicides are not impulsive Risk does not increase with discussionRisk does not increase with discussion

Facts about SuicideFacts about Suicide

Page 37: Understanding Mental Illness  A Review of the Disorders

Prior attempts increases risk Prior attempts increases risk by 33%by 33%

Mental illness increases the Mental illness increases the risks - risks - 61% have major depression61% have major depression48% have personality disorder48% have personality disorder40% Alcohol use40% Alcohol use10% Anxiety10% Anxiety6% Schizophrenia6% Schizophrenia

Understanding SI behavior Understanding SI behavior increases prevention!increases prevention!

Facts about SuicideFacts about Suicide

Page 38: Understanding Mental Illness  A Review of the Disorders

Why Jails are Suicide Prone SettingsWhy Jails are Suicide Prone Settings

Authoritarian environmentAuthoritarian environment Loss of control over futureLoss of control over future IsolationIsolation ShameShame DehumanizingDehumanizing

aspects of aspects of

incarcerationincarceration

FearsFears Police and Jail staff Police and Jail staff

immune to arrest and immune to arrest and incarcerationincarceration

Officers and jail staff Officers and jail staff overlook or overlook or misunderstand misunderstand symptoms symptoms

Page 39: Understanding Mental Illness  A Review of the Disorders

Terms related to SuicideTerms related to Suicide

AmbivalenceAmbivalenceIdeationIdeationLethalityLethalityAttempt Attempt GestureGesture

Page 40: Understanding Mental Illness  A Review of the Disorders

Evaluation ToolEvaluation ToolThe Sad Persons ScaleThe Sad Persons Scale

SSexex AAgege DDepressionepression

PPrevious Attemptsrevious Attempts EEthanolthanol RRational Thinking Lossational Thinking Loss SSocial Support Lossesocial Support Losses OOrganized Planrganized Plan NNo Spouseo Spouse SSicknessickness

Page 41: Understanding Mental Illness  A Review of the Disorders

Why Do People Die by Suicide?Why Do People Die by Suicide?

ImpulsiveImpulsiveDepressedDepressedEscape from sufferingEscape from sufferingCommunicationCommunicationLoss of a loved oneLoss of a loved one

Page 42: Understanding Mental Illness  A Review of the Disorders

Understanding Suicidal Thinking Understanding Suicidal Thinking

Suicide is a solution to a problem, what is the Suicide is a solution to a problem, what is the problem ?problem ?

Most suicides are acts to end intolerable Most suicides are acts to end intolerable feelingsfeelings Coping Patterns FailCoping Patterns Fail ““Tunnel Vision” interferes with seeing alternativesTunnel Vision” interferes with seeing alternatives Person feels “unheard”Person feels “unheard” AmbivalenceAmbivalence

Page 43: Understanding Mental Illness  A Review of the Disorders

Recognizing Suicidal Risk In JailRecognizing Suicidal Risk In Jail

Psychological Factors Psychological Factors

Social Risk FactorsSocial Risk Factors

Behavioral Warning SignsBehavioral Warning Signs

Page 44: Understanding Mental Illness  A Review of the Disorders

Special Features of Jail Suicide RiskSpecial Features of Jail Suicide Risk

Legal Status Factors Legal Status Factors

Time of the yearTime of the year

Long Term FactorsLong Term Factors

Page 45: Understanding Mental Illness  A Review of the Disorders

InterveningIntervening

Create a safe Create a safe environmentenvironment

Only one person Only one person communicate communicate

Talk about planTalk about plan Emphasize positivesEmphasize positives

Evaluate potentialEvaluate potential Refer for treatmentRefer for treatment Do not lieDo not lie

Page 46: Understanding Mental Illness  A Review of the Disorders

PreventionPrevention

Admission ScreeningAdmission Screening Utilize a formal screening worksheetUtilize a formal screening worksheet Develop tiered assessments - intake, Develop tiered assessments - intake,

supervisor, mental health professional referralsupervisor, mental health professional referral Observe for risk factors, even after intakeObserve for risk factors, even after intake Assure treatmentAssure treatment

Page 47: Understanding Mental Illness  A Review of the Disorders

Collaboration and The Team Collaboration and The Team ApproachApproach

Page 48: Understanding Mental Illness  A Review of the Disorders

Shared GoalsShared Goals

Diversion of inmates from jail to appropriate Diversion of inmates from jail to appropriate community carecommunity care

Assure adequate mental health care while Assure adequate mental health care while incarceratedincarcerated

Assure Continuity of Care for those inmates at the Assure Continuity of Care for those inmates at the time of their release.time of their release.

Page 49: Understanding Mental Illness  A Review of the Disorders

Steps to Meeting Shared GoalsSteps to Meeting Shared Goals

Screening and Screening and identificationidentification

EvaluationClassificationEvaluationClassification DiversionDiversion Crisis PreventionCrisis Prevention

Provision of emergency Provision of emergency mental health servicesmental health services

Assure careAssure care Supervision Supervision Suicide PreventionSuicide Prevention Pre release planningPre release planning

Page 50: Understanding Mental Illness  A Review of the Disorders

Team Approach OptionsTeam Approach Options

Employ Mental Health StaffEmploy Mental Health Staff Formal Contractual Agreements with ProvidersFormal Contractual Agreements with Providers Informal Agreements (MOA)Informal Agreements (MOA)

Page 51: Understanding Mental Illness  A Review of the Disorders

Characteristics of a good Working Characteristics of a good Working SystemSystem

Shared Vision, mission and valuesShared Vision, mission and values Involvement of all stakeholdersInvolvement of all stakeholders Established written documentationEstablished written documentation Formal and informal verbal communicationsFormal and informal verbal communications Ongoing CommitmentOngoing Commitment

Page 52: Understanding Mental Illness  A Review of the Disorders

Formal AgreementsFormal Agreements PurposePurpose Range of ServicesRange of Services Time FrameTime Frame Remuneration, if applicableRemuneration, if applicable Expectations of the jail re documentation, Expectations of the jail re documentation,

referrals, medication administration, etcreferrals, medication administration, etc ConfidentialityConfidentiality Mechanism for review, evaluation and Mechanism for review, evaluation and

modificationmodification

Page 53: Understanding Mental Illness  A Review of the Disorders

Comprehensive Service ArrayComprehensive Service Array DiversionDiversion Timely and effective treatmentTimely and effective treatment Placement in programmingPlacement in programming Linkage with support groupsLinkage with support groups Housing assistanceHousing assistance Educational AssistanceEducational Assistance EntitlementsEntitlements Other supportsOther supports

Page 54: Understanding Mental Illness  A Review of the Disorders

Systematic PlanningSystematic Planning

CooperationCooperationCoordinationCoordinationCollaborationCollaborationIntegrationIntegrationKey Issues Identification of problems, barriers Key Issues Identification of problems, barriers

and solutionsand solutions

Page 55: Understanding Mental Illness  A Review of the Disorders

Technical Assistance ResourcesTechnical Assistance Resources

• National Institute for Corrections (Jail Center) 1-National Institute for Corrections (Jail Center) 1-800-995-6429800-995-6429

• The GAINS Center for People with Co-Occurring The GAINS Center for People with Co-Occurring Disorders in the Justice System 1-800-311-GAINDisorders in the Justice System 1-800-311-GAIN