Crisis intervention team (CIT) training for police forces seems like a good idea, yet little is known about the outcomes of such training despite 20 years of experience.
At the APA Institute on Psychiatric Services in New York in October, researchers from Georgia and Illinois began to fill in that gap, reporting results from early studies of CIT programs.
An estimated 10 percent of police contacts with the public involve people with mental illness, turning officers into defacto triage personnel. Traditionally, police cadets get only an average of one to two hours of information about mental illness during their training, leaving them poorly equipped to judge the behavior of mentally ill individuals in a confrontation.
CITs began in 1987 after officers killed a mentally ill man in Memphis. The Memphis Police Department and the local branch of the organization now known as the National Alliance on Mental Illness worked with mental health professionals and community members to teach the police better ways to manage their interactions with people with mental illness. The concept proved popular. Today, there are an estimated 400 CIT programs for local and state law enforcement units in the United States.
"The goal is to get the subjects medical treatment rather than criminal incarceration, reduce stigma, and improve safety," said Michael Compton, M.D., M.P.H., of Emory University in Atlanta. He and Beth Broussard, M.P.H., reported on the Georgia program, which has trained about 3,000 officers in at least 50 of the state's 159 counties.
Typically, officers volunteer for CIT training. The training usually consists of 40 hours of course work and field experience that include the science of mental illness, visits with mentally ill people, and techniques to deescalate potentially violent encounters. Some of the training includes role playing by the police or actors who are mental health consumers. Police dispatchers also undergo special training so they know when to send a CIT team.
Compton and his colleagues performed nine small pilot studies to lay the groundwork for a larger study funded by the National Institute of Mental Health (NIMH) that is now under way. Several of these studies showed that officers who took the CIT training displayed a scientifically informed understanding of mental illness, a greater knowledge of mental health issues, less stigma, and less social distancing from people with mental illness.
The researchers also hypothesized that as more police officers got CIT training, the use of special weapons and tactics (SWAT) teams might decline. In fact, they found no correlation between the two in a study of administrative data from 1999 to 2007.
"SWAT teams and CIT address different situations," said Compton. "When the SWAT team is called, the situation has already developed beyond what the CIT is trained for."
Another survey of 88 police officers, taken an average of two years after the training, found a slight but significant decline in their knowledge. That decline correlated not with time elapsed since the training, as Compton expected, but inversely with the number of years an officer had been on the force. The longer they had served, the less decline in knowledge they displayed.
"Perhaps longer-serving officers may be better choices for joining a CIT," he suggested.
Another study of 48 officers with CIT training and 87 without used several escalating vignettes to evaluate when they were likely to resort to physical force to control a subject. The untrained officers were more likely to choose physical force sooner in the escalating scenario, and CIT-trained officers rated the value of nonphysical force more highly.
However, whether that is due to training is still unclear, said Compton. "The key may be who chooses to enter CIT training."
For one, among the volunteers for CIT training, there were higher proportions of women officers and of officers who knew someone who had received psychiatric treatment compared with police personnel who had not volunteered for the training.
The Emory researchers have received an NIMH grant to determine how CIT training relates to behavioral attitudes and intentions, deescalation skills, and actual mental health referrals. In the future, they also hope to look at both officer-level and patient-level outcomes.
Chicago's CIT program began in two police districts in 2005, training 30 to 40 officers and supervisors in each district, said Amy Watson, Ph.D., an assistant professor in the Jane Addams College of Social Work at the University of Illinois at Chicago. The program expanded to all 25 of the city's districts a year later. Close to 1,000 officers have now been trained.
CIT-trained officers have increased referral of individuals to mental health services by 18 percent. However, there was no difference in the rates of arrest between trained and untrained officers. Regardless of their training or lack of it, all officers seemed to know when it was more appropriate to arrest than to refer for treatment.
CIT training may not be the only factor influencing an officer who has to decide between arresting subjects and sending them to a mental health service site, said Watson. If a supervisor is pressing officers to resolve a situation quickly so they can move on to another call, they may resort more quickly to arrest rather than take the time to talk with a subject to determine the ideal approach to the problem.
Watson, too, expects future research to reveal the effects of CIT training on the experience of mentally ill people in contacts with the police. In the meantime, CIT training will remain just one tool to help police reduce the risk of harm to themselves and to those with mental illness.
"CIT is not the only or even the best approach for dealing with these people," said Compton. "Mobile crisis teams may be the best approach because CIT is a police-based response when other systems don't exist or are not available."