Crisis Intervention Teams
Responding to Mental Illness Crisis Calls
By Johnny K. Jines, M.A.
According to statistics, approximately one in 17 Americans, or 6 percent of the population, live with a mental illness. Further, in any given year, about one in four Americans, equaling 57.7 million people, experience a mental health issue.1 Many people are diagnosed with these conditions; however, those with more serious mental illnesses (SMI) sometimes command the attention of law enforcement. An SMI constitutes a behavioral or emotional disorder, diagnosable within the past year, resulting in serious functional impairment.2
Due to the extreme behavior exhibited by individuals with SMI, encounters with police during a crisis sometimes end in tragedy. As a best practice, the implementation of a Crisis Intervention Team (CIT) plays an important role in responding to these situations. The concept of these teams has existed for over 25 years. Known as the Memphis Model, from its origin with the Memphis, Tennessee, Police Department, it successfully has been established in several jurisdictions.
The primary goal of CITs involves calming persons with mental illness who are in crisis and referring them to mental health care services, rather than incarcerating them. This goal, based on five objectives, includes lessening injuries to officers, alleviating harm to the person in crisis, promoting decriminalization of individuals with mental illness, reducing the stigma associated with mental disorders, and using a team approach when responding to crises.
Necessity
“If we always do what we’ve always done, we’ll always get what we’ve always got.”3 In regard to community relation issues, agencies periodically should examine where they are, where they want to be, and how they will get there. This applies to all phases of law enforcement. Dealing with individuals in mental health crisis is no exception.
Certain similarities and differences exist across America among law enforcement organizations that respond to mental health issues and other social problems. Although not a cure-all, implementing a CIT provides a viable method for agencies seeking another option. Whether searching for a new approach or simply looking to improve an existing one, agencies should consider the Memphis Model. Recognizing the need for a best practice for responding to mental health crisis calls becomes paramount in proceeding with this plan.
Determining the most effective approach to mental health issues within a particular community remains complex. The most optimal way to understand the needs and concerns of citizens consists of talking with those most affected. People have their own perspectives on responding to mental health crises; therefore, meeting to share information and discuss resources becomes the first step in obtaining the necessary support. The best way to determine the status of an issue requires agencies to obtain an overview of how those involved will react. To verify whether assets are underutilized or duplicated, organizations compare available resources.
Sergeant Jines serves as a patrol division shift supervisor and Crisis Intervention Team trainer with the Jackson, Tennessee, Police Department.
Cooperation and communication between agencies remains invaluable. The success of CITs in any community depends on reaching a consensus on which tasks each organization performs best and understanding the legal requirements surrounding this complex response.
Training
Weeklong basic CIT training consists of 15 training modules of varying lengths. These courses, usually given in order, include:
- Introduction to Clinical Issues Relating to Mental Illness
- Introduction to Psychotropic Medications
- Substance Abuse and Co-Occurring Disorders
- Post-Traumatic Stress Disorder (PTSD)
- Cultural Awareness
- Suicide Prevention
- Rights and Civil Commitment Law
- Family and Consumer Perspective
- Traumatic Brain Injury (TBI)
- Developmental and Disruptive Disorders of Childhood and Adolescents
- Introduction to Verbal Techniques
- Borderline and Other Personality Disorders
- Basic Strategies of De-Escalation
- Advanced Verbal Techniques and Practicum
- Community Resources
Most law enforcement training academies conduct an abbreviated class on dealing with mental health crises. However, CIT members benefit from in-depth, rigorous training that provides a more heightened sense of awareness and competency. Each encounter between law enforcement and the public varies dramatically with every interaction maintaining its own dynamic nature.
Benefits
The benefits received from this training include gaining knowledge of psychotropic medications, understanding how this information can alert law enforcement personnel to someone with a possible mental condition, and learning how to interact safely with the person. People with mental illness often experience co-occurring disorders of alcohol and drug abuse. Knowledge of this situation aids law enforcement in understanding the challenges presented by these complex issues.
Training on PTSD and TBI provides valuable resources for handling these problems. Many law enforcement professionals recognize the effects of PTSD and TBI. Stressful vocations and situations, such as the military, sometimes trigger PTSD. Many military personnel have been exposed directly or indirectly to the horrific consequences of war. The effects of this exposure may not be known for many years. In addition to PTSD, many of these veterans suffer from TBI because of exposure to detonated improvised explosive devices (IEDs), dramatically affecting their quality of life. Law enforcement and the community must deal with these concerns now and in the future because these issues cannot be ignored.
The Cultural Awareness, Suicide Prevention, and Rights and Civil Commitment Law courses present equally important benefits. Addressing the differences and similarities among various cultures within the community establishes a long-lasting, proactive, and equitable approach to these mental health concerns. Knowledge of laws on rights and civil commitment prevents agencies from taking wrong actions and assists them in choosing correct ones.
“According to statistics, approximately one in 17 Americans, or 6 percent of the population, live with a mental illness.”
Principles
Many organizations have policies. These are based on three pivotal principles for responding to individuals with mental illness. These principles include:
- Standing alone, mental illness signifies and requires no special response. Persons with mental illness have the right to be left alone unless they are violating a law or posing a risk of harm to themselves or others.
- Persons shall not be placed in police custody because of mental illness alone. The exercise of law enforcement authority, such as detaining or arresting an individual, only should be done if the person is involved in criminal activity or poses an immediate threat according to statute.
- No individual will be treated as someone with a mental illness unless it becomes necessary. The first two principles protect the basic right to be left alone unless the individual is involved in criminal activity, others are threatened with harm, or a person’s life is in mortal danger. The third principle addresses the stigma attached to the label of “mentally ill” and the potential harm this may produce.
Training heightens compassion and communication, which are invaluable in developing CIT members. Teams learn to start with basic communication skills. Once they master these, officers proceed to the advanced and complex practical exercises.
CIT trainees comment that field day provides them with the most satisfaction. Attendees spend the day among an inpatient mental health care facility, peer-support center, and veteran’s administration facility. Participants interact with people from varying backgrounds who have experienced a mental health crisis, been diagnosed, and received treatment. They engage in productive dialogue with these individuals regarding the best methods for handling crisis encounters.
Cost-Effectiveness
The expense to implement and maintain a CIT outweighs the cost of not establishing a program. As a result of this strategic approach, injuries to law enforcement personnel and individuals with mental illness diminish significantly, and repeat calls for these issues decrease. Law enforcement officers direct persons with mental illness to mental health care facilities for treatment prior to issuing any criminal charges. This process reduces lawsuits, medical bills, and jail costs and improves the quality of life for the community.4
Law enforcement budget constraints often dictate priorities. Of course, some agencies possess larger budgets and can implement more strategic changes, while others struggle to meet basic demands. For the latter, the importance of shared resources becomes a considerable factor for responding to community needs.
Whether large or small, an agency’s bottom line focuses on making the biggest impact for the fewest dollars. The savings associated with CITs significantly impacts the community. One cost reduction comes from fewer injuries to officers, which results in minimal work hours lost and lower medical bills. Injuries to persons with mental illness also are reduced, lessening the possibility of legal entanglements. The decriminalization of mental illness uses jail diversion techniques to reduce costs—meals, lodging expenses, medical care, medications, and transportation—associated with incarceration. Individuals with mental illness go directly to a mental health care facility for proper treatment.
This does not eliminate the person’s accountability. Authorities deal with criminal charges resulting from the individual’s episode after the crisis has been stabilized and resolved. Agencies participating in this response model should establish mental health courts within their jurisdictions. These courts hear criminal charges arising from the mental health crises separate from cases of other defendants.
“Determining the most effective approach to mental health issues within a particular community remains complex.”
With these special court appearances, the individuals, judges, attorneys, mental health care professionals, advocates, family members, and others involved in the process meet under conditions more favorable than in a traditional criminal court setting. Several means exist to address the underlying mental health issues related to the criminal act. The individual with mental illness and the court sometimes agree to a mandatory outpatient treatment agreement. Court orders specify that, as a condition of a suspended sentence, the individual must meet certain criteria—take medications as directed, make scheduled mental health care appointments, and pay restitution for damages incurred during the episode. Another concern consists of diminishing the stigma attached to mental illness. Many persons with mental illnesses prefer to be labeled a criminal, rather than mentally ill.5 This clearly indicates the depth of onus attached to these illnesses.
Organization
Cooperation between agencies constitutes a key element to successfully implementing a CIT. The investment from all stakeholders—law enforcement, mental health care professionals, advocacy groups, family members, the judicial system, and other concerned community organizations—serves a vital role in organizing and sustaining the process. There are over 2,500 law enforcement agencies across the United States, in addition to some international locations, that have maintained CITs for several years.6 Organizing, planning, and maintaining a CIT requires hard work and dedication. Teams formed with committed participants are the most likely to succeed.
Conclusion
Many agencies use similar models for responding to service calls involving mental health crises. When a model meets the needs of the community, there is no reason to change. A writer and university professor once said, “There is nothing as useless as doing efficiently that which should not be done at all.”7 Therefore, if changing models serves only to moderately improve efficiency then adopting that measure is not necessary.
“The expense to implement and maintain a CIT outweighs the cost of not establishing a program.”
Ideally, agencies consider a variety of factors before instituting the Crisis Intervention Team process. Careful consideration for identifying community needs, available resources, and level of cooperation and interest from stakeholders all play an important role in the success of the CIT process. Agencies should understand that providing some training in this area is better than supplying none at all.8 For law enforcement organizations seriously considering revitalizing an existing strategic plan or implementing a new model for responding to mental health crises, a CIT presents an excellent option.9
Endnotes
1 National Alliance on Mental Illness (NAMI), www.nami.org (accessed April 10, 2012).
2 National Survey on Drug Use and Health, www.nimh.nih.gov/statistics/SMI_AASR.shtml (accessed April 10, 2012).
3 Quote from Tony (Anthony) Robbins, American life coach, motivational speaker, and bestselling writer.
4 National Alliance on Mental Illness (NAMI).
5 The Crisis Intervention Institute at the University of Memphis, Memphis, Tennessee, www.cit.memphis.edu (accessed April 16, 2012).
6 U.S. Department of Justice, Office of Community Oriented Policing Services, People with Mental Illness (Washington, DC, 2006).
7 Quote from Peter Drucker, writer, management consultant, university professor, and 2002 Presidential Medal of Freedom winner.
8 National Alliance on Mental Illness (NAMI).
9 National Alliance on Mental Illness (NAMI).
“Cooperation and communication between agencies remains invaluable.”