Article Review Crisis intervention team training for police officers responding to mental disturbance calls

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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
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ARTICLE REVIEW

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In the article, “Crisis intervention team training for police officers responding to mental
disturbance calls”, Teller et al. assess the effect police training incorporated by police
departments all over the country on the officers’ outlook of the calls concerning the mental
illness crisis. The training aimed at avoiding cases where there were incarcerations or arrests
instead of more appropriate actions such as treatment and referral to mental health physicians
(Teller et al., 2006). The research was conducted through the analysis of the police dispatch logs;
this was bound to determine the calls rates related to the mental disturbances, the nature of the
calls by training and time as well as the effects of the methods on the voluntariness of nature.
The purpose of this study was to conclude whether the officers trained under the crisis
intervention team model (CIT) had a huge chance of responding to mental ill individual calls
which were undergoing a certain crisis through transferring them to a mental healthcare facility.
This was opposed to leaving the individuals at the scene or worse arresting them. The study
further determined whether the individuals taken to healthcare facilities did that voluntarily, or
the trained officers forced them...


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