Deinstitutionalization dramatically shifted the locus of mental healthcare from psychiatric hospitals to the community. Concurrently, law enforcement officers' role as frontline responders to mental health crises increased considerably. This development is daunting for both law enforcement and mental healthcare providers. Without special knowledge and skills, police response to complex mental health crises often results in greater risk of violence, arrest, and incarceration (or control) of persons with mental illness, rather than referral to mental health services for treatment.1 Both criminal justice and mental health systems consider these risks unacceptable.2
In response, a number of collaborative efforts between law enforcement and local mental health providers have emerged, falling under the rubric of police-based (or prebooking) diversion programs.2,3 A comparison of common prebooking diversion designs showed that, overall, collaboration among the criminal justice, mental health, and advocacy systems, along with access to essential services, reduced injuries, inappropriate arrests, and incarcerations, while increasing referrals to treatment.3
Furthermore, early research findings indicate that response teams comprised of officers specially trained through crisis intervention team (CIT) training, coupled with streamlined referral for evaluation and treatment, result in: (1) increased specialized response to disturbance calls with a mental health component, (2) significantly lower arrest rates, (3) less use of force, and (4) higher treatment referral rates than other models. 3-5 However, research on prebooking programs is in its infancy, and prospective studies are needed to support this evidence.
Officer Robert F. Mizones of Chicago's 20th District and Thresholds member Mark Gonciarz conduct a role-play session to help Mizones learn how to better handle crises involving consumers with mental health issues. Cathy Lewis is in the background. Photography by Roark Johnson Photography
The CIT Model
Following a 1987 police shooting involving a person with mental illness, the Memphis chapter of the National Alliance on Mental Illness (as it is now known), the Memphis police department, the University of Memphis, and the University of Tennessee partnered to develop a specialized CIT within the police department.3 The purpose was two-fold: (1) to offer police officers intensive training and certification as specialized first-line responders to crisis calls in which mental health issues are identified or suspected, and (2) to develop and support partnerships between police departments and the local mental health systems and facilities.
The training component of the CIT program offers volunteer officers 40 hours of training about mental illness and techniques for effective crisis intervention (e.g., deescalation skills) provided by mental health providers, family advocates, and mental health consumer groups. The partnership-building aspect involves improving communication, sharing resources, and conducting strategic planning to address two different (but related) priorities: improving safety during crises and reducing the criminalization of persons with mental illness.7 A notable outcome of CIT training, which cuts across these priorities, is that it appears to increase officers' confidence in the effectiveness of their mental health crisis interventions and lessens stigma toward individuals with severe mental illness (schizophrenia in particular).8,9