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
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