Long known as "curbside counselors" because of their
frontline-role in dealing with crises involving mentally ill individuals,
police are now educated to back up the nickname. A growing number of police
departments nationwide have adopted a new approach to interact more
effectively and more safely with people with mental illness.
Under the program, known as Crisis Intervention Teams (CITs), communities
train individual volunteer officers to know how mental illness manifests and
best practices for dealing with those with mental illness in the field.
Another arm of the program designates continuously available facilities where
mental health professionals always accept police detainees with signs of
mental illness. The final but critical aspect of the CIT program is to form
partnerships with the mental health community so health professionals and
those with mental illness can learn how the police operate and provide
feedback on ways to improve the program.
Although the programs vary somewhat in different localities, program
participants and researchers said in interviews with Psychiatric News
and in published studies that the CIT program appears highly effective and
among the best options for police departments looking to better handle
situations involving people with mental illness.
"We're convinced that by providing additional skills to the officers,
they have been able to de-escalate situations that in the past they might have
not been so successful with," said Mark Munetz, M.D., chief clinical
officer of the Summit County (Ohio) Alcohol, Drug Addiction, and Mental Health
Services Board. Thus, individuals who are brought "to our emergency
psychiatric facility are in better shape; they are calmer and often more
willing to accept help. So it is a terrific program."
The CIT program began in Memphis, where police were looking for a better
response to calls concerning people who displayed severe emotional
disturbances than arresting and incarcerating them.
In 1988 the Memphis Police Department began working with the local chapter
of the National Alliance on Mental Illness (NAMI) and two local universities
to organize and implement the first CIT program and train officers.
The program now includes about 225 voluntary officers who have had 40 hours
of special training from mental health professionals and psychiatrists, family
advocates, and consumer groups. The training, like many CIT programs, includes
instruction on the basics of psychiatry and psychology and de-stigmatizing
mental illness, understanding the symptoms of these conditions, explaining the
mechanics of the local mental health system, and learning de-escalation
techniques. A part of the deescalation mindset is the practice of referring to
individuals as "customers" instead of "suspects" or"
"This is probably the most challenging because it is helping
officers—within the framework of their own safety and the public
safety—learn how to talk more effectively to people in a mental health
crisis," said Munetz, who runs training for an Akron, Ohio, CIT program."
In their regular training they are generally taught to take command and
be in charge, and a lot of what we teach is being lower key, more patient, and
more soothing in their approach."
The number of officers trained—a common CIT guideline is 25 percent
of the force—allows some CIT officers to be available regardless of the
day or time of an emergency call requiring CIT help.
Having a designated mental health facility to receive people whom CIT
officers detail for erratic or disruptive behavior was critical for police to
accept the program because it allows them to return to their patrols as
quickly as a simple arrest would.
The Memphis program has since spread to police departments throughout
Tennessee and in several other states, including Ohio, Texas, North Carolina,
Iowa, Oregon, New Mexico, and Washington.
In Ohio the Department of Mental Health developed a coordinating"
center of excellence" to promote CIT and other jail-diversion
efforts, which has led to more than 1,200 volunteer officers' receiving
training since May 2000, according to Munetz, a professor and acting chair of
the Department of Psychiatry at the Northeastern Ohio Universities College of
Medicine in Rootstown, Ohio.
Although no national study has yet been completed on CIT programs, several
limited studies have found them effective and superior to other law
enforcement approaches for dealing with individuals with mental illness.
A comparison of the leading police approaches to better handle people with
mental illness found CIT programs were superior in having fewer arrests of
those who displayed mental illness and a higher likelihood that they would be
taken for treatment. The study, in the May 2000 APA journal Psychiatric
Services, compared the outcomes of the Memphis CIT program with those of
the civilian counselor teams who work with police in Birmingham, Ala., and the
Knoxville, Tenn., mobile crisis units of specially trained officers.
The study found only the CIT model included a dedicated crisis triage
center with a policy of not refusing police cases, which was at least
partially responsible for CIT's much greater response to "mental
disturbance" calls. The small number of personnel in the Birmingham and
Knoxville programs resulted in those units' frequent unavailability to respond
to mental disturbance calls.
The study found that CIT officers were less likely to arrest someone in a"
specialized response" case (2 percent) than either the civilian
counselor team (13 percent) or the mobile-crisis units (5 percent). CIT
resulted in 75 percent of individuals in such cases being taken to a treatment
location, while that happened for only 20 percent of the Birmingham cases and
42 percent of the Knoxville cases.
In comparison, more than 3,000 individuals have been processed by CIT
officers in the Akron program since May 2000, with about 75 percent
transported for treatment and 6 percent arrested, Munetz said.
"What I have found in my research and field work is that none of the
programs is as extensive at CIT," said Bonnie Sultan, CIT technical
assistance coordinator for NAMI. "There are some other options
available, but CIT is the gold standard."
Sultan is conducting the first national study of CIT programs with the
Council of State Governments and the Police Excellence Research Forum. Her
study will identify the number of CIT programs, the number of jail-diversion
programs, the number of individuals who are involved in each program, the
types of training and personnel used, and funding sources. The results will be
released in April.
Meanwhile, the number of CIT programs is expected to increase. One sign of
that expected growth: The CIT programs' first national conference in 2005 had
more than 700 attendees, when organizers expected only about 250.