How does violence potential affect Crisis Intervention Team responses to emergencies? (2008)

Introduction

When individuals with mental illness are involved in an emergency situation or public disturbance, police officers often are called to intervene. In fact, police contacts, arrests, and “other encounters with the legal system are regular occurrences” ( 1 ) for many of these individuals. These police contacts can be problematic. Although police may initiate psychiatric hospitalization for those who pose a danger to themselves or others, they do so relatively rarely ( 2 ). In fact, observation of 506 relevant encounters indicated that the police were 67% more likely to arrest an individual with mental illness than his or her healthy counterpart ( 3 ). Police who do not recognize irrational speech, an inability to obey commands, and other symptoms of mental illness may respond punitively to such aberrant behavior. Occasionally, these encounters result in injury or death for individuals with mental illness and well-publicized outcries over the police’s use of force.

Some of these incidents have prompted jurisdictions to adopt specialty police programs for individuals with mental illness. One widely adopted ( 4 ) program is the crisis intervention team (CIT) ( 5 ), which involves two main components. The first is a team of selected volunteer police officers who complete 40 hours of training on mental illness, treatment, and strategies for defusing psychiatric crises. CIT officers are available throughout the city, around the clock, to respond to relevant calls. The second component is a psychiatric emergency room that responds immediately to individuals transported by CIT officers, reducing the bureaucracy and hours of waiting that can lead officers to choose arrest over hospitalization.

Enthusiasm for the CIT model is based partially on a handful of nonexperimental studies suggesting that the approach increases safety during officer encounters with persons under investigation and might divert appropriate cases from jail to treatment. With respect to the latter point, three studies suggest that CIT links persons with treatment but may not reduce their likelihood of arrest. First, a comparison of 100 calls handled by three jail diversion programs indicated that CIT had the lowest rate of arrest (2%) and the highest rate of transportation to treatment services (75%) ( 6 ). Second, a one-year follow-up of over 1,000 jail detainees who were or were not enrolled in jail diversion programs, including CIT ( 7 ), indicated that the diverted sample was more likely to receive medication and counseling, less likely to receive emergency and inpatient services, but no more likely to improve in symptoms or arrest rates. Third, a pre-post analysis of CIT ( 8 ) indicated that, compared with officers without CIT training, CIT-trained officers were more likely to transport individuals to treatment but no less likely to arrest them.

Although even fewer studies address the primary CIT goal of increasing safety, the results are promising. A comparison of the three years before and after CIT was adopted in Memphis indicated decreases in officer injuries for mental health-related calls (from .04 to .01 per 1,000) ( 5 ).

Such findings are often interpreted as evidence that CIT-trained officers effectively defuse situations that might lead to the use of force on individuals with mental illness. After all, CIT emphasizes verbal deescalation for handling potential violence. Nevertheless, extant designs cannot rule out the possibility that officers simply encountered fewer dangerous mental health calls over time. This study is the first to assess the risk of violence to self or others posed by these situations and examine officers’ use of force in light of that risk. Are CIT officers able to respond to dangerous situations with relatively little use of force?

This study focused on incident reports for events handled by approximately 200 CIT-trained officers in Las Vegas. This program modified the Memphis model in one major respect: the crisis triage center could not function as a drop-off site for officers at the time of this study. Although officers collaborated closely with local hospitals and ambulance providers to ensure a pipeline to services, this study was an evaluation of CIT training rather than the full model with an emergency center.

This study explored the extent to which this program meets its goals of promoting safety and appropriate jail diversion. Its aims were to assess the nature of events to which CIT officers were called to respond, including a person’s potential for violence; estimate the quality of CIT officers’ skills in defusing crises by comparing an individual’s potential for violence with officers’ use of force; and examine the frequency of dispositions that involved treatment versus arrest.

 

Skeem, J.L., & Bibeau, L. (2008). How does violence potential affect Crisis Intervention Team responses to emergencies? Psychiatric Services, 59, 201-204. doi:10.1176/appi.ps.59.2.201