8.9 Application of Less Lethal Weapons
by Law Enforcement Officers

(8.9.1)    The National Alliance on Mental Illness (NAMI) believes that the use of conducted energy devices (including stun guns, tasers, impact delivery systems, or any other similar non-firearm weapons)used by law enforcement officers responding to individuals with serious mental illness should be permitted only if the responding officer concludes that an immediate threat of death or serious injury exists, which cannot be contained by lesser means, and/or is likely to be hazardous to the officer(s), the individual, or a third party.  Such devices should not be deployed when other means or methods of de-escalations are appropriate, available, and suitable for the crisis event, nor   should these devices ever be used as a means of intimidation or inappropriate coercion.

(8.9.2)       NAMI further believes that states should include, in statute, a requirement for the development and enforcement of standards and minimum training requirements for all law enforcement, corrections and other personnel who use or may potentially use these devices in the performance of their duties.  This mandatory training must include information about effective methods of responding to people with mental illness in crisis with verbal and non-verbal crisis de-escalation techniques.

(8.9.3)     States should also strictly define in statute categories of professionals who are authorized to use these devices in the performance of their duties and should strictly prohibit usage of these devices by those not identified as authorized users in statute.

(8.9.4)       NAMI calls upon the states and the federal government to fund and promote research that documents the incidence of use of these devices and investigates both the short term and long term physical and psychological impact on people who have experienced the application of such devices.  This research also should determine the potential dangers associated with risk factors, including but not limited to age and pre-existing medical conditions.

(8.9.5)      Each use of these devices should be investigated by the respective law enforcement agency or institution in the same way that use of a firearm would be investigated by a law enforcement agency.

By Eugene O’Donnell | Newsweek Web Exclusive

Barely concealing his anger, Chaplain Thomas Nangle told an overflow funeral mass for Chicago policeman Richard Francis that the 60-year-old officer did not give his life in the line of duty—rather, it was “taken” from him.

Days before, on July 2, Francis, a 27-year veteran of the force, responded to a call steps from the police station where he was assigned. An emotionally disturbed person—EDP in police parlance—had fought with another passenger on a city bus. Before Francis could calm the woman, she grabbed his gun and shot him in the head. All too predictably, family members of the woman, Robin Johnson, told reporters that they had tried to get the woman help as her life slipped downhill.

From coast to coast, mentally ill people, without reliable access to the costly on-demand care they need, are left to fend for themselves. In the aftermath of the movement in the 1970s to close large mental asylums, many of today’s mentally ill are left to their own devices; they are often homeless and without full-time advocates. With government unable or unwilling to properly serve this population, the criminal-justice system is left to pick up the slack.

Contrary to what many assume, the mentally ill are most often the victimized, not the victimizers. A 2005 study by researchers at the Feinberg School of Medicine at Northwestern University suggested that persons with serious mental illnesses are 11 times more likely than the general population to be victims of violent crime, with perhaps as many as 1 million crimes committed against those with serious mental-health issues each year.

But relying on the police to address the problem has too often resulted in tragedy, not only on the mean streets of big cities but in quieter places as well. In Silverton, Ore. (population, 7,500), a 20-year-old Irish immigrant, Andrew Hanlon, described by friends and family as suffering from paranoia and delusions, was shot and killed by a police officer investigating a report that Hanlon was trying to break into a residence on June 30. The officer who shot Hanlon told a grand jury—which voted not to indict him—that he thought Hanlon had wielded a broken bottle. At a candlelight vigil attended by 100 people, friends of the deceased man questioned the use of deadly force, saying that the police should have known the man was more of a local character than an actual threat and that he was banging on doors, not trying to break into anyone’s home. The killing drew international attention. The same cannot be said about the shooting death, nine days later, of a homeless, emotionally disturbed 40-year-old Newark, N.J., man, Francisco Martes, who was shot by police after allegedly waving a knife at an officer. This more “typical” EDP incident garnered little press coverage beyond the usual police-blotter report.

Experts on treatment say the police for the most part do a good job handling the millions of interactions they have each year with the mentally ill. But is it irresponsible to ask them to undertake duties that perplex even trained, savvy professionals? “The police are not meant to be street-corner psychologists,” says Dr. Linda A. Teplin of Northwestern University, one of the authors of the 2005 report about mentally ill crime victims. She notes the chronic shortage of beds for the mentally ill in treatment facilities, something that results in fewer stays, shorter stays and the reality that “you have to be extremely mentally ill” to get one of them. There is also a pressing need for more housing for this population. For law enforcement, experts say more training and more nonlethal weapons such as the controversial Taser could be beneficial.

Following the deaths of two people in Rhode Island this year in separate encounters with police, Rep. Patrick Kennedy secured a grant of $200,000 to enhance police training for responding to the mentally disturbed. After a third person, a man in police custody, died, Kennedy called for the creation of a statewide crisis-intervention team that would be available to handle cases of emotionally disturbed individuals.

Pressured by media coverage about mentally ill people committing serious crimes, New York city and state officials recently acknowledged major failings in mental-health care and oversight and in the exchange of information between mental-health providers and law enforcement. A task force recommended training New York Police Department dispatchers, who handle roughly 90,000 calls annually regarding the emotionally disturbed, to ask better questions so that the officers responding have more information.

The task force also called for the creation of a location database with call histories involving the mentally ill so that specially trained emergency-service officers can be dispatched more expeditiously. Another proposal: to establish Mental Health Care Monitoring Teams in New York City, which would help coordinate and track the care of high-need clients. According to the New York Daily News, $13 million will be spent to create a sophisticated tracking system that will improve the continuity of mental-health care, identify when individuals requiring care cease treatment and speed up interventions for high-risk people when, for example, they stop taking anti-psychotic medications.

And New York plans to expand its use of mental-health courts and to share information from the tracking system with criminal-justice agencies to improve treatment of mentally ill individuals who are arrested. Civil-liberties groups are watching warily to make sure that the information collected by the database does not end up being used against mentally ill defendants.

The New York report cited the “struggle” that facilities are faced with in treating tens of thousands of mentally ill persons under correctional supervision. Thomas Faust, the former executive director of the National Sheriffs’ Association, has said that the large growth in many correctional facilities is due to a lack of mental-health resources. The three largest de facto mental-health facilities in the country, he wrote in 2003, are actually jails: “Riker’s Island (in New York City), Los Angeles County and Cook County [in Chicago].” An estimated one in five prisoners in these facilities receive or require daily mental-health attention—treatment they would likely be denied in the outside world.

According to a 2000 report by the federal government’s National Institute of Justice, once a mentally ill person is arrested for disorderliness, that person is labeled a “criminal” and will likely continue to be arrested when acting out in the future, rather than receive treatment.

In a presidential-election year featuring a Republican candidate who prides himself on straight talk and a Democrat who suggests the nation adopt a new can-do ethos, perhaps there is a glimmer of promise that the dialogue on criminal justice this fall can extend past the archetypical embrace of blame and “toughness” and examine the 50-state crisis in mental-health care. On the streets, there is hard work to be done.

O’Donnell is a professor of police studies and law at John Jay College of Criminal Justice in New York City.

From Minnesota Health Care News, February 2007

By Mark Anderson

The human brain is a wonder to behold. It brings us consciousness and insight, it invents science and philosophy, and creates the performance of the Olympic athlete and the jazz musician. But like any other organ of the body, it can suffer from illnesses and injuries. When the brain gets in trouble we see the symptoms of mental illness. And when the individual struggling with these symptoms becomes overwhelmed, a mental health crisis can occur.

When people in your family or community experience a mental health crisis, they might be reacting to any number of physical and mental conditions. They might hear voices as if listening to a non-existent radio or as if there is another person inside their head. They might see beings or other objects that are not real, or experience changes in perception, (e.g., of colors). They might be having profound delusions such as believing that threatening figures are plotting against them. They might be struggling with severe depression and contemplating suicide. They might be experiencing the high energy, erratic behavior and sleeplessness of mania. Or they might not realize they have memory loss and impulsivity caused by physical or chemical brain trauma.

A mental health crisis can be any one of the scenarios in this broad spectrum because many parts of the brain can be in crisis. And of course these and other symptoms can occur in combination. So there are many behaviors that we might observe in an event known as mental health crisis. Those who are not mental health professionals need not diagnose the illness. Even highly-trained scientists and clinicians struggle to find an accurate diagnosis in many cases.

But we can all help people in crisis by helping them get to the professional help they need. That means helping them find safe transportation to a crisis center equipped to respond to psychiatric illness. In many cases this help can bring the individual back to mental health so they can resume their life, or even find a more fulfilling life.

A crisis in your home or community

If someone exhibits symptoms of a mental health crisis, you should proceed with caution and restraint. In most cases, a person in crisis is very vulnerable and is not a threat to public safety. You may be able to transport the person to the nearest hospital. If you do, be prepared for a long wait, up to eight hours or longer are common. Having you there will help the health care professionals understand the nature of the crisis that brought you to their facility, and you can serve as a valuable advocate for the person in crisis. Don’t be afraid to speak up strongly on behalf of the person you brought in.

In some cases, it is best to seek immediate help. If a weapon is involved or there apprears to be a danger to public safety, then it is appropriate to call 911. The 911 caller should describe the behavior that is observed at the scene and ask the 911 operator to dispatch a mental health crisis responder. It is important to describe the specific behavior because the dispatcher makes an independent assessment whether this is a mental health crisis call. And the more specific the information is, the more likely the responders will be prepared when they arrive at the scene. More and more police departments have CIT (Crisis Intervention Team) officers, specifically trained to respond to mental health crisis calls. And many counties in Minnesota now have Mobile Crisis Teams of mental health professionals. It is likely that the mobile crisis team will have its own phone number independent of the 911 system.

While the responder is on the way to the crisis it is important to make efforts to de-escalate the crisis, if this can be done safely. Express your support and concern to the person in crisis. Listen to his story. Give him space so he doesn’t feel trapped and try to reduce stimulation by limiting the number of people and other distractions. Speak slowly and softly, and avoid touching, shouting or continuous eye contact. When the responders arrive, offer your assistance but let them do what they are trained to do and don’t interfere.

Developing an emergency plan

Before any crisis occurs it is helpful for family members to have developed a plan for handling such an event, similar to handling any health care emergency, but with a focus on the unique aspects of a mental health crisis. Many crises can not be anticipated. But you foresee the possibility of such an occurance with a family member or close friend, you should be prepared. You should create a packet for yourself that includes contact information for a physician and or therapist who knows the person’s health history, the county mobile crisis team, the local police, or other first responders in your community. Mental health responders often have their own phone numbers and sometimes won’t be dispatched through the 911 system.

Each community has a different array of resources to respond to mental illness. Having a conversation with a community mental health center or an emergency psychiatric facility where first responders take those in crisis is an important part of developing a strategy for responding to a mental health crisis.

Prevention: the best outcome

Prevention of the crisis in the first place is the best outcome. Each additional crisis event a person experiences can cause further damage to the brain. And a crisis and the response to the crisis can be unpredictable, and can unfortunately sometimes even lead to injury or death. We all need to plan ahead and know what resources are available in our own local community, so we are prepared in case we need to respond to a mental health crisis.

Prevention also means that we all need to combat stigma and discrimination that people with mental illness face. Individuals that are struggling with mental health problems should be encouraged and supported to seek health care. Community education can help combat stigma so that anyone struggling with mental illness can receive support from others in the community. Part of this process of being prepared is having improved understanding of cultural sensitivities and attitudes to mental illness. Different cultures understand mental illness and mental health care in different ways and knowledge of these differences can often improve the quality of a crisis response.

A tragic case

Even though it occurred over six years ago, the death of Barbara Schneider on June 12, 2000, is still remembered by many in Minnesota. She was shot in her Uptown, Minneapolis home by police during a confrontation in a mental health crisis call. Since that incident, mental health advocates have worked with their partners in criminal justice, and emergency medicine to improve the response to crisis events and to work toward de-criminalization of mental illness. Only a strong partnership between the mental health, criminal justice, and emergency medicine communities can improve crisis response to those who need this help.

Another vital part of improving crisis response is public education about the nature of mental illness, removing the social stigma of mental illness, and improving the resources available to help those who need care. Getting this message out to the public and to policymakers will result in more appropriate and effective mental health crisis response, improved first responder safety, and growing collaboration among everyone involved.

Such collaboration can prevent tragic events like Barbara Schneider’s death and ensure that our families and communities are safer and healthier places to live and work.

Mark Anderson is Executive Director of the Barbara Schneider Foundation, and leads their efforts to build mental health/criminal justice collaborations in training, education and advocacy.

By Jennifer L. S. Teller, Ph.D., Mark R. Munetz, M.D.,
Karen M. Gil, Ph.D. and Christian Ritter, Ph.D.
Psychiatr Serv 57:232-237, February 2006
doi: 10.1176/appi.ps.57.2.232
© 2006 American Psychiatric Association

Abstract

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.

Introduction

Police officers are recognized as first responders for individuals who are experiencing a mental illness crisis (1,2,3,4). 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 appropriate (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 (7,8,9).

Partnerships between law enforcement and mental health systems may 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-CIT-trained 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 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 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 two-day 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 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 CIT-trained 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.

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 unknown. 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. After implementation 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, CIT-trained 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, which suggests that training status did not affect arrests. However, CIT-trained 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 CIT-trained 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. 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 effects 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 timely intervention in the treatment system may prevent future emergencies, even if the situation at hand does not mandate transport. On the other hand, CIT-trained officers may use their training to deescalate and counsel individuals so that no further emergency intervention is needed. As CIT has evolved in Akron, the police and mental health systems have been developing outreach programs so that people who may not need emergency mental health intervention receive appropriate mental health follow-up. The effects of such programs on the rate of calls that do not involve the arrangement of transport remain to be seen. At this point, however, it appears that the significant difference in the rate of calls that did not involve transport between CIT-trained and non-CIT-trained officers reflects a desired outcome.

We cannot explain with certainty the observation that after implementation of the CIT program there was a decrease in involuntary transports for both CIT- and non-CIT-trained officers. It may be that the emphasis during training on use of verbal deescalation techniques to avoid escalation of crises filtered throughout the department, or it may be that CIT-trained officers are referred the more challenging cases, which could mask the effects of training. In any case, all stakeholders perceive this outcome as a positive one.

The apparently higher rate of arrest by CIT-trained officers was unanticipated. Mental health systems support CIT programs in part because they view the programs as prearrest diversion programs. Police agencies, on the other hand, embrace the CIT program as a means of enhancing officer and community safety. Through CIT training, officers may learn when referral to the mental health system is most effective and when arrest may be preferable. As noted above, it is possible that dispatchers are sending CIT officers to the most challenging mental disturbance calls, for which officers may have less discretion as to whether to arrest the individual. That this might be the case could be supported by the fact that the initially significantly higher arrest rate by CIT-trained officers disappeared and differences in significance between CIT-trained and other officer groups in both transport to other treatment and no need for transport appeared after calls handled by emergency medical services were excluded from the analyses. Emergency medical services handled 54 percent of calls attended by non-CIT-trained officers both before and after the CIT program was implemented but handled only 42 percent of calls attended by CIT-trained officers. Removal from the data of primarily nonpsychiatric medical calls, for which officers lack discretion about disposition, clarified the differences between the groups of officers. CIT-trained officers’ arrest rates were not significantly different from those of the other officer groups, but the CIT-trained officers transported mentally disturbed individuals to treatment facilities more often.

Furthermore, it is likely that Akron arrest rates are influenced by officers’ knowledge of the Mental Health Court postarrest diversion program. The Akron Mental Health Court began in January 2001, shortly after the start of the CIT program (12,13). This court is for misdemeanants with severe and persistent mental illness who receive intensive community-based treatment in lieu of incarceration. Court personnel participate in CIT training to explain the program and to encourage officers to refer the individuals they arrest to the mental health court. Knowledge of the program and the fact that it may help individuals who may otherwise be resistant to treatment to live successfully in the community may result in CIT-trained officers’ choosing arrest in selected cases. The interaction of prearrest diversion programs such as the CIT program and postarrest programs such as the mental health court should be the subject of future research.

Given that these results are not based on experimental data, it is not possible to make causal assertions about the effects of police training on dispositions. That is, officers were not randomly assigned to training. Furthermore, officers were acting as their own controls by using the pre-CIT program as a comparison group. Ideally, we would have liked to have similar data from a community that did not have a CIT program as an additional comparison group. Despite these limitations, the findings are important.

In addition, future research should consider the effects of the circumstances surrounding the call. A complementary study that examined qualitative CIT-trained officers’ field reports (manuscript in preparation) had similar findings, suggesting that although CIT programs may have a significant impact on police referral for treatment and decreased use of force and involuntary commitment, these programs may not reduce arrests of people with mental illness. Only a study of the circumstances of each arrested individual, the nature of the charges, and the officer’s rationale for arrest will help explain these findings. Future examination of narrative reports on each CIT encounter will address these questions.

CIT programs require a partnership between law enforcement and mental health systems as well as consumers of mental health services and their families. Each stakeholder group may desire overlapping but somewhat different outcomes. It is likely that CIT programs will differ depending on the mental health and criminal justice systems’ community resources. As data accumulate on the effectiveness of CIT programs, communities will need to decide whether the outcomes warrant the considerable investment in the program. If CIT enhances the safety of both officers and consumers but does not reduce the arrest rate, for example, will courts and jail administrators support it?

Conclusions

The implementation of a crisis intervention team (CIT) program for police officers has led to an increased number and proportion of calls recognized by police dispatch as potentially involving mental illness. Training has led to increased transport of persons who are experiencing a mental illness crisis to emergency evaluation and treatment facilities, and transport is more likely to be on a voluntary basis compared with officers who have not participated in the training. This finding suggests that the CIT partnership between the police department, the mental health system, consumers of services, and their family members can help in efforts to assist individuals who are experiencing a mental illness crisis and interacting with the criminal justice system to gain access to the treatment system, where such individuals most often are best served. The expected effects on arrest rates were not clearly demonstrated. Future research is needed to examine decisions to arrest and to understand the interactions between multiple programs such as CIT and mental health courts and to learn how different CIT program elements lead to desired outcomes.

Acknowledgments

This research was supported by the Ohio Department of Mental Health (grant 02.1176) and the Ohio Office of Criminal Justice Services (grant 2002-DG-C01-7068). The authors thank the following officers of the Akron Police Department for their assistance and patience: Lt. Michael Woody (Ret.), Sgt. Michael Yohe, Michael Carillon, Lt. Michael Prebonick, and Chief Michael T. Matulavich. The authors also thank the following students who assisted in data cleaning: Natalie Bonfine, Sue Drexel, Marcee Jones, Ashley Kilmer, Kris Kodzev, Marnie Salupo Rodriguez, Dana Sohmer, and Joyce Wall.

Footnotes

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.

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