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Crisis Intervention Team Training
for Police Officers Responding
to Mental Disturbance Calls
Jennifer L. S. Teller, Ph.D.
Mark R. Munetz, M.D.
Karen M. Gil, Ph.D.
Christian Ritter, Ph.D.
Objectives: In recognition of the fact that police are often the first responders for individuals who are experiencing a mental illness crisis,
police departments nationally are incorporating specialized training for
officers in collaboration with local mental health systems. This study examined police dispatch data before and after implementation of a crisis
intervention team (CIT) program to assess the effect of the training on
officers’ disposition of calls. Methods: The authors analyzed police dispatch logs for two years before and four years after implementation of
the CIT program in Akron, Ohio, to determine monthly average rates of
mental disturbance calls compared with the overall rate of calls to the
police, disposition of mental disturbance calls by time and training, and
the effects of techniques on voluntariness of disposition. Results: Since
the training program was implemented, there has been an increase in
the number and proportion of calls involving possible mental illness, an
increased rate of transport by CIT-trained officers of persons experiencing mental illness crises to emergency treatment facilities, an increase in transport on a voluntary status, and no significant changes in
the rate of arrests by time or training. Conclusions: The results of this
study suggest that a CIT partnership between the police department,
the mental health system, consumers of services, and their family members can help in efforts to assist persons who are experiencing a mental
illness crisis to gain access to the treatment system, where such individuals most often are best served. (Psychiatric Services 57:232–237, 2006)
P
olice officers are recognized as
first responders for individuals
who are experiencing a mental
illness crisis (1–4). In the absence of
specialized training in mental illness
and knowledge about the local treatment system, such crises may end in
arrest and incarceration when referral
and treatment might be more appro-
priate (5,6). The absence of collaboration between law enforcement and
mental health systems has been posited as one factor in the emergence of
the complex phenomenon known as
the criminalization of persons with
mental illness (7–9).
Partnerships between law enforcement and mental health systems may
Dr. Teller and Dr. Ritter are affiliated with the department of sociology of Kent State University, Kent, Ohio 44242 (e-mail, jteller@kent.edu). Dr. Munetz is with the Summit
County Alcohol, Drug Addiction, and Mental Health Services Board in Akron, Ohio, and
with the Northeastern Ohio Universities College of Medicine in Rootstown. Dr. Gil is with
Akron General Medical Center and Northeastern Ohio Universities College of Medicine.
232
PSYCHIATRIC SERVICES
address this problem. One such collaboration is the crisis intervention
team (CIT) model, started in 1988 by
the Memphis Police Department
(10). The CIT program provides intensive training about mental illness
and the local system of care to patrol
officers, who then are available to respond to mental disturbance calls.
The idea has spread nationwide, and
approximately 70 departments have
formed their own CIT programs (personal communication, Cochran S,
October 9, 2004).
Although clearly intended to increase officers’ skills in deescalation
of crises among persons with mental
illness, CIT partners may seek different—although complementary—outcomes. Law enforcement may be
most interested in improving the
safety of both officers and consumers
during potentially dangerous encounters, whereas mental health may focus more on decreasing inappropriate
arrests of persons with mental illness.
In this article, we examine disposition of mental disturbance calls before and after implementation of one
city’s CIT program. The purpose of
the study reported here was to determine whether CIT-trained officers
were more likely than non–CITtrained officers to respond to calls involving individuals with mental illness
who were experiencing a crisis by
transporting the person to a health
care facility and less likely to either
arrest the person or leave the person
at the scene. Furthermore, for cases
in which an officer determined that
♦ ps.psychiatryonline.org ♦ February 2006 Vol. 57 No. 2
transportation to a treatment facility
was necessary, we examined whether
the transportation to treatment was
voluntary or involuntary, by officers’
CIT training status.
The program in Akron, Ohio, began in May 2000 with the collaboration of the Akron Police Department;
the Summit County Alcohol, Drug
Addiction, and Mental Health Services Board and its provider agencies; the National Alliance for the
Mentally Ill (NAMI) of Summit
County; the Summit County Recovery Project; and the Northeastern
Ohio Universities College of Medicine (NEOUCOM). Two major modifications were made to the Memphis
program to account for differences in
services available. Akron, unlike
Memphis, has a freestanding psychiatric emergency service, which means
that individuals who have a comorbid
nonpsychiatric medical condition
may be referred to a general hospital
emergency department instead of or
before going to psychiatric emergency services. In addition, Akron’s
emergency medical services dispatch
a paramedic unit to emergency calls
identified as involving persons with
mental illness. In general, emergency
medical services are in charge of
nonpsychiatric medical calls, and the
police are in charge if a call is due primarily to manifestations of mental illness without comorbid medical complications. As a result, paramedic
lieutenants from the Akron Fire Department were included in initial
training.
The first weeklong training occurred in late May 2000 with 20
Akron police officers and three paramedic lieutenants from the Akron
Fire Department. All officers were
volunteers and were screened by the
training director to determine their
appropriateness for this team of officers who were most likely to encounter individuals experiencing
mental illness crises. Communication
skills and being self-motivated to improve skills and knowledge about
mental illness were the prime selection criteria for the program. Officers
received a 40-hour introduction to
mental health and mental illness with
an intensive overview of the local
mental health system and its points of
PSYCHIATRIC SERVICES
access. Officers visited psychiatric
emergency services, went into the
community with case managers, and
visited a consumer-directed social
center. They received extensive training in verbal deescalation skills and
engaged in realistic role playing to
practice these skills in simulated
crises at the NEOUCOM Center for
the Study of Clinical Performance.
Officers were encouraged to consider, when appropriate, linkage and referral for care to the mental health
system as a preferable alternative to
arrest.
CIT-trained officers began patrolling in the Akron community on
May 27, 2000. Training was provided
annually for new team members. Excluding officers who have been promoted or have retired, currently 66
of 243 active patrol officers (27 percent) are CIT trained (personal communication, Yohe M, July 29, 2004).
In addition to training for officers as
detailed above, refresher training
sessions have been held annually
since 2003. These sessions are for
supplementary mental health training and to identify areas in program
implementation where difficulties
exist for officers and the people they
serve. Modified annually, the twoday refresher course has included
updates on legal and medical issues,
research results, advanced techniques in negotiation and suicide
prevention, and taser techniques,
procedures, and qualification.
CIT officers handle situations they
encounter on patrol or through dispatch. Dispatchers evaluate emergency calls and have two codes for
mental disturbance calls: suspicion of
mental illness and suicide attempt in
progress. Once on the scene, responders may determine that the call does
not involve a person with mental illness. Conversely, other codes—for
example, fights—may involve a person with mental illness but may not
be coded by dispatchers as a call related to a mental disturbance.
Methods
We obtained institutional review
board approval from all applicable
agencies before beginning the project. Data were analyzed for the two
years before and the four years after
♦ ps.psychiatryonline.org ♦ February 2006 Vol. 57 No. 2
implementation of the CIT program
by using SPSS, version 12.0. The
Akron Police Department provided
data on the number of calls for assistance. All calls that were coded as
mental disturbance calls by police
department dispatchers from May
1998 through April 2004 were made
available to the research team. These
calls included the call date, the time,
whether CIT team members were
present, police code corresponding
to disposition of the call, and notes
from the Akron Police Department
and emergency medical services.
Notes were evaluated to determine
disposition location and information
about which agency was in charge of
the call (the Akron Police Department, emergency medical services,
or another agency, such as the coroner, the local jail, or a mental health
agency). Notes were consulted to determine whether the officer who
transported the individual to a treatment facility initiated an involuntary
commitment process.
The number of calls for assistance
per month and the number of calls related to a mental disturbance per
month were summed per year (May
through April), and the rate of mental
disturbance calls per 1,000 Akron police department calls per month was
calculated. Analysis of variance
(ANOVA) statistics were calculated.
If the means were significantly different at the p<.05 level, one-way ANOVA Scheffé’s post hoc tests were run to identify categories of difference. Compared with other tests, Scheffe’s is a conservative estimate, because larger differences in means are required for significance. Percentages and chi square statistics were calculated for the dispositions of calls by time and training. Time was dichotomized as either the two years before implementation of the program (May 1998 through April 2000) or the four years after (May 2000 through April 2004). Training was dichotomized as either CITtrained or non–CIT-trained. Analysis of variance was calculated on the basis of disposition proportions. If the means were significantly different at the p<.05 level, Scheffé’s post hoc tests were run to identify categories of difference. 233 Table 1 Dispositions of mental disturbance calls for persons experiencing a mental illness crisis, by crisis intervention team (CIT) training status of police officers, for calls handled by either the Akron, Ohio, Police Department or emergency medical services CIT training status Before CIT program implementation After CIT program implementation Non–CIT-trained officers CIT-trained officers Total a b Transport to psychiatric emergency servicesa Transport to other treatment facility Transport to jailb N N N % % Police interaction, no need for transport Total % N % N % 750 26.5 965 34.1 84 3.0 1,034 36.5 2,833 100 1,126 581 2,457 26.9 29.5 27.3 1,447 639 3,051 34.6 32.5 34.0 100 80 264 2.4 4.1 2.9 1,512 667 3,213 36.1 33.9 35.8 4,185 1,967 8,985 100 100 100 F=3.13, df=2, 8,982, p=.044; Scheffe’s test showed a significant difference between CIT-trained officers and the other two groups (p<.05). F=6.62, df=2, 8,982, p=.001; Scheffe’s test showed a significant difference between CIT-trained and non–CIT-trained officers after implementation of the CIT program (p<.001). Results Proportion of mental disturbance calls From May 1998 through April 2004, the Akron Police Department received 1,527,281 calls for service, of which 10,004 were related to mental disturbances. The average number of calls per month (21,212) was stable over the six-year study period (data not shown). The total number of calls per year increased slightly over the six years, although not significantly. The two years before implementation of the program and the year of implementation were significantly different from the last two years studied (p<.006). There was an absolute increase in the number of calls identified as mental disturbance calls and in the rate of calls related to mental disturbances per 1,000 calls for assistance (F=9.39, df=5, p≤.001) as well as a proportional increase (F=15.86, df=5, 66, p≤.001). Disposition of calls for mental disturbances Initially there were seven disposition categories: transport to psychiatric emergency services; transport to another treatment location, such as an area hospital or detoxification facility; transport to a jail; police interaction with no need for transport (for example, giving advice, assisting, or talking to the person); other transportation (including to a shelter or residence); no police interaction (for example, the officer was unable to locate the individual); and disposition un234 known. Over the six-year period, almost 25 percent of the 10,004 mental disturbance calls resulted in transportation to psychiatric emergency services, and 31 percent resulted in transportation to local hospitals or another treatment facility. Thirty-two percent of the calls involved police interaction with no need for transport. Almost 3 percent of the calls resulted in an arrest. Slightly fewer than 8 percent resulted in no police interaction, and 2 percent involved some nontreatment transport; in less than .5 percent of the calls the disposition was undetermined. We continued our analyses with four disposition categories: transport to psychiatric emergency services, transport to another treatment location, transport to jail, and police interaction with no transport. The other three categories were not analyzed, because these three disposition categories do not appear relevant to understanding police interaction with individuals who are mentally disturbed. Eliminating these categories decreased the sample size by about 10 percent to 8,985. Disposition by officers’ CIT training status Table 1 is a cross-tabulation of the four disposition categories by time and training: before the CIT program, non–CIT-trained officers after implementation of the CIT program, and CIT-trained officers after implementation of the CIT program (χ2=21.58, df=6, p=.001). After imPSYCHIATRIC SERVICES plementation of the program, the overall rate of transport to jail decreased slightly, from 3.0 percent to 2.9 percent. When we compared the two groups of officers after implementation of the program, CITtrained officers were more likely than non–CIT-trained officers to have transported persons with mental disturbances to jail (4.1 percent compared with 2.4 percent), although the difference was not significant. When CIT-trained officers’ interactions were compared with those of the other two groups, CIT-trained officers were also more likely to have transported persons with mental disturbances to psychiatric emergency services and less likely (although not significantly less) to have transported them to other treatment facilities. CIT-trained officers were also less likely to have interactions involving no need for transport than were other officers, either before or after implementation of the CIT program, but, again, the difference was not significant. The fact that emergency medical services were in charge in the case of some of the calls may have masked the effects of training, because there may not be opportunities to use deescalation techniques in emergency settings. Table 2 shows dispositions by officers’ CIT training status after removal of these nonpsychiatric medical calls (N=4,367). With these calls excluded, there was no longer a significant difference in arrest rates between the three groups, ♦ ps.psychiatryonline.org ♦ February 2006 Vol. 57 No. 2 Table 2 Dispositions of mental disturbance calls for persons experiencing a mental illness crisis, by crisis intervention team (CIT) training status of police officers, for calls handled by the Akron, Ohio, Police Department CIT training status Before CIT program implementation After CIT program implementation Non–CIT-trained officers CIT-trained officers Total a b c Transport to psychiatric emergency servicesa Transport to other treatment facilityb Transport to jail N N N % % % Police interaction, no need for transportc Total N % N % 336 25.8 174 13.4 84 6.5 706 54.3 1,300 100 510 377 1,223 26.6 32.8 28.0 236 183 593 12.3 15.9 13.6 100 80 264 5.2 7.0 6.0 1,071 510 2,287 55.9 44.3 52.4 1,917 1,150 4,367 100 100 100 F=8.98, df=2, 4,364, p<.001; Scheffe’s test showed a significant difference between CIT-trained officers and the other two groups (p=.001). F=4.04, df=2, 4,364, p=.018; Scheffe’s test showed a significant difference between CIT-trained and non–CIT-trained officers after implementation of the CIT program (p=.019). F=20.697, df=2, 4,364, p<.001; Scheffe’s test showed a significant difference between CIT-trained officers and the other two groups (p<.001). which suggests that training status did not affect arrests. However, CITtrained officers were significantly more likely than either of the other two groups to take mentally disturbed persons to psychiatric emergency services and less likely to be involved in calls for which there was no need for transport. Compared with non–CIT-trained officers for the period May 2000 through April 2004, CIT-trained officers were significantly less likely to be involved in calls for which there was no need to transport the individual. Before implementation of the CIT program, 10.6 percent of people who were transported for treatment were transported on an involuntary legal status. There was a significant decrease in the involuntariness of transport after implementation of the program for both non-CIT- and CITtrained officers, as can be seen from Table 3. Discussion Since the CIT program began, there has not been an increase in the volume of all calls, but the absolute number of mental disturbance calls and the proportion of such calls have increased. We suspect at least two possible explanations for this increase in the number of calls related to mental disturbances after implementation of the CIT program. First, the dispatchers may have been more aware and better prepared to assess a call as involving a person with mental illness. PSYCHIATRIC SERVICES Second, with the community’s knowledge of the CIT program and the participation of NAMI, callers may have been more likely to acknowledge the involvement of a person with mental illness. Since the program began, family members have reported that they are more comfortable calling the police to request help for a loved one, and consumers of mental health services have reported calling the police to request help for themselves or their peers. A number of findings suggest that the program is meeting the desired outcomes for both sides of the partnership. Compared with nontrained officers, trained officers are more likely to transport a person for treatment than they were before the program was implemented. Training ef- fects may explain this difference, given that recognition of symptoms of mental illness and knowledge of options for treatment are part of CIT training. The study showed that trained officers are less likely to end calls without arranging for transport of the person involved. This issue is complex. Police officers on the scene have considerable discretion (1,11). For officers in general, the less time-consuming course is to rule out an emergency and resolve the call without arranging transport. CIT-trained officers presumably appreciate the fact that tim ... Purchase answer to see full attachment

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