Crisis intervention teams (CITs) housed within police departments, sheriff’s offices, and other law enforcement entities represent an intersection of law enforcement and psychology to enable a proper law enforcement response to those with mental health needs who are in crisis or need assistance. A CIT typically comprises specially trained police officers and/or mental health professionals. This article reviews the origins of CITs, the different ways these teams are organized and utilized, and the training of their members and, through a number of case examples, highlights what these teams are able to accomplish as compared with a more typical police response to those in a mental health crisis.
Origins
Origins of CITs began in the late 1980s in Memphis, TN, where the police department and a number of local mental health agencies and universities collaborated in the creation of a police training program. Born in part by economic factors, an increasing homeless population with mental health issues experienced more and more run-ins with the police, yet the officers did not have adequate training to handle these types of situations. The different agencies began working together on the street, culminating in the creation of a specific training for police officers called the Crisis Intervention Training.
Training
The training of CIT officers typically entails increasing their understanding of psychiatric conditions such as schizophrenia and other psychotic disorders, bipolar disorder, depression, anxiety disorders such as post-traumatic stress disorder, and substance use disorders. Training also focuses on giving officers information and practical experience (typically through role-play exercises and through visits to local psychiatric care facilities), deescalating and intervening with people with these disorders. Officers are also given information about ways to address short-term needs of people in a mental health crisis (e.g., safety plans and no-harm contracts) as well as knowledge about local treatment and assistance options (e.g., programs that assist with life skills training, employment and housing opportunities, financial assistance, counseling, and medical aid).
These CIT training programs augment police academy training. Specifically, CIT officers are shown how to approach someone in a nonthreatening manner (as opposed to the authoritative approach emphasized in basic police academy training) and how to listen empathetically, paraphrase, slow emotions down, help individuals move to a cognitive state, and provide understanding and support. These were the aspects of the Memphis Police Department’s CIT program training that made it novel and effective. The implementation of the program was also unique in that many officers did not trust or understand the mental health community, but were now working closely and effectively by providing alternatives to jail for this population.
A benefit of having CIT-trained officers is a reduction in the number of use of force incidents. For instance, officers are trained in their police academy to take control of a situation upon arrival. This approach works very well in many situations but can be counterproductive in, for example, the case of a psychotic person. Recognizing the signs of psychosis and then taking a CIT approach to this person can often help deescalate these potentially lethal situations. CIT officers learn that the best approach, while maintaining officer safety, is to avoid crowding the individuals and overstimulating them with commands and physical presence. That authoritative approach can cause a psychotic person to become combative and thus provoke the use of force on the part of responding officers. Research on the effectiveness of CIT indicates that officers with this training often use less force and are more likely to refer individuals with psychiatric conditions to mental health services instead of taking them to jail.
Since the introduction of the Memphis Model of CIT, other departments have adopted similar trainings and programs. For example, Texas has a 40-hr Mental Health Police Officer certification for officers with over 2 years of law enforcement experience. Generally speaking, there are three different ways of implementing a CIT program. The first is the Memphis Model that trains officers in CIT and has made them respond to these types of calls for police service. The second method, the collaborative model, is to pair a police officer, preferably CIT-trained, with a mental health professional, to patrol together, responding to calls for service. The third method, often referred to as a Victims Services Unit or Crisis Team, trains mental health professionals to patrol and respond to police requests for assistance.
Additionally, CIT programs within law enforcement agencies do not always work only with mentally ill subjects. Other common uses of Victims Services Teams or Crisis Teams are a mental health response to assist people who have witnessed or experienced the death of a loved one (e.g., homicide, suicide, or by natural causes) and to assist victims of sexual assault, domestic violence, traffic accidents, suicidal persons, and other calls in which the presence of a mental health professional may be of benefit to those involved. A Victims Services Team or Crisis Team response to these types of calls often allows police officers to return to service more quickly, and those involved can receive support and referral information not commonly offered by police officers. Because this third method often allows officers to return to service, it is growing in popularity. Andrew Young, Jill Fuller, and Briana Riley researched this type of CIT program and found that both officers and victims benefit from the assistance, psychological support, and referral resources provided by these teams.
CIT programs are sometimes used to assist officers as well. A common example is a Crisis Incident Stress Management team comprising Crisis Incident Stress Management–trained officers, mental health professionals, and sometimes chaplains. This team assists officers after emotionally difficult or traumatic calls in order to give officers a safe place to decompress and process their experiences. Examples of calls traumatic for police officers are officer-involved shootings, extended or physically demanding operations, mass casualty incidents, the death of a child, and other events not commonly experienced by police officers. A Crisis Incident Stress Management team response may be as simple as a one-on-one chat with an officer after a difficult call or may take the form of a group meeting in which officers similarly exposed to a traumatic event can process that event together. This group meeting is often referred to as a psychological debriefing and guides officers through a specific seven-step protocol that helps them cognitively and emotionally process the event and offer support to one another.
Another example of law enforcement officers and mental health professionals working together in addressing crises is the use of psychological consultants on SWAT negotiating teams. Typically, these consultants help assess the mental status of the subject holding hostages, who is barricaded, or who is threatening suicide, and provide negotiating and response strategies to the officers intervening with the subject in crisis.
Case Example 1
Officers were called to a local apartment complex regarding an individual brandishing a rifle at neighbors after an argument about an improperly parked vehicle. As responding officers approached the apartment, the individual pointed his rifle in the direction of officers as he turned to retreat into his apartment. Officers took up defensive and protected positions and then initiated a SWAT response. Through the course of negotiating with this individual, and interviewing family and friends, it came to light that this individual was a combat veteran and had been seeking assistance from the U.S. Department of Veterans Affairs for post-traumatic stress disorder. The SWAT negotiator on this call, who was CIT-trained and a combat veteran, was able to build rapport with the barricaded subject and to offer support, reassurance, understanding, and empathy. The officer then worked with this veteran on a safe plan for exiting his residence. Once taken into custody, a decision had to be made. Do officers arrest this man for aggravated assault (for pointing a rifle at responding police officers), or do they facilitate sending this man to an inpatient care facility because he is a danger to others due to his hypervigilance (being on guard, seeing threats everywhere, and responding automatically from his combat training), which is associated with post-traumatic stress disorder? In this case, due to the input from his family who was on scene, from the psychological consultant with the SWAT negotiating team, and due to his response to and compliance with the CIT officer, it was determined that remand to an inpatient facility would be the best way to resolve this situation.
Case Example 2
Officers are called because a man is on the roof of his house, naked, pointing toward the sky, and having an animated conversation with someone who is not there. The police, the fire department, and ambulance service all arrive and receive no response from the man to their calls to him from ground level. The CIT officer on scene realizes that this man probably has a psychotic disorder (though hard to say if it is substance-induced or caused by a mental health condition) and seeks to ground this man in reality by asking the man to look at him, talk with him, and take a break from his conversation. After approximately 30 minutes of taking this approach and receiving no response, the CIT officer then claps his hands loudly and yells the man’s name, which was given to the officer by a neighbor. The man breaks off from his conversation and is then able to engage the officer in answering a couple of questions before returning to his conversation with the air. After another 30 minutes of going back and forth between conversations with the air and the CIT officer, the man safely climbs down a ladder and gets into the waiting ambulance to be transported to the local emergency room for a physical and psychological assessment.
CITs began by trying to fill a need within law enforcement—bridging the gap between the basic training of police officers and the needs of people in crisis and/or with mental health conditions. Since its origin in Memphis, the use of CIT teams has broadened with the law enforcement community using mental health professionals in a variety of situations to provide for the needs of those in crisis and to mitigate the long-term effects of crisis. CIT teams are an important part of many law enforcement responses, especially those that may not solely be a criminal matter.
References:
- Borum, R. (2000). Improving high risk encounters between people with mental illness and the police. Journal of the American Academy of Law and Psychiatry, 28, 332–337.
- Compton, M., Bahore, M., Watson, A., & Oliva, J. (2008). A comprehensive review of extant research on Crisis Intervention Team (CIT) programs. Journal of the American Academy of Law and Psychiatry, 36, 47–55.
- Erstling, S. (2006). Police and mental health collaborative outreach. Psychiatric Services, 57(3), 417–418. doi:10.1176/appi.ps.57.3.417-a
- Heilbrun, K., DeMatteo, D., Yasuhara, K., Brooks-Holiday, S., Shah, S., King, C., . . . Laduke, C. (2012). Community-based alternatives for justice-involved individuals with severe mental illness. Criminal Justice and Behavior, 39, 351–419. doi:10.1177/0093854811432421
- James, R., & Gilliland, B. (2013). Crisis intervention strategies. Belmont, CA: Brooks/Cole.
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- Michell, J., & Everly, G. (1997). Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers. Ellicott City, MD: Chevron.
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- Young, A. T. (2016). Fight or flight: Negotiating crisis on the front line. Chambersburg, PA: eGen.
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