Crisis Intervention Teams Enhance Safety of Police, Patients

“Physical force is rarely used in police encounters involving persons with serious mental illness, and the strongest predictor of the use of force by police officers is resistance by the subject,” said Michael Compton, M.D., M.P.H., director of Research Initiatives in Psychiatry and Behavioral Sciences at George Washington University School of Medicine and Health Sciences.

Compton chaired and spoke at the symposium “Police Encounters With Individuals With Serious Mental Illnesses” at APA’s 2012 annual meeting in Philadelphia in May. He and his copresenters discussed the use of Crisis Intervention Team (CIT) training, a model of partnership between mental health and law enforcement that seeks to reduce use of force and enhance safety of officers and individuals with mental illness.

CIT training arose in the late 1980s in Memphis when the highly publicized death of a man with a mental illness led to an outcry for a more skilled approach to such cases. Since then, the so-called “Memphis model” has been implemented in numerous cities and counties.

The program provides a specialized 40-hour training that equips police officers with knowledge and skills needed to enhance their response to individuals with mental illness and safely handle mental health crisis situations. In addition, officers are educated about collaborations between mental health facilities and the police department, as well as other resources to assist in redirecting individuals with mental illness away from jails and into treatment facilities when appropriate.

Compton has been instrumental in evaluating the effectiveness of CIT training, leading several studies of the implementation of CIT teams in communities. In the most recent of such studies, published in the July 2011 Schizophrenia Bulletin, Compton and his colleagues hypothesized that CIT-trained officers would report a lower level of force used during an escalating crisis situation and that those officers would perceive lower levels of force as more effective than officers not trained in the CIT model.

The researchers sampled 135 officers in the Atlanta Police Department, 48 of whom had received CIT training. The study design was a vignette-based, self-administered survey requiring approximately 15 to 20 minutes. Each survey contained three scenarios depicting an escalating situation involving a subject with psychosis.

Their results supported their hypothesis, leading them to state, “Efforts are needed to reduce use of force toward individuals with psychotic disorders. … These findings suggest that CIT may be an effective approach. In addition to clinical and programmatic implications, such findings demonstrate a role for clinicians, advocates, and schizophrenia researchers in promoting social justice through partnerships with diverse social sectors.”

One question that has hounded the concept of CIT training is whether officers who choose to participate are pre-disposed to be more empathic. Compton and his colleagues considered that question and reported in the June 2011 Psychiatric Services the results of their before-and-after assessment of 177 officers—including 109 non-CIT-trained officers, 24 officers assigned to CIT training, and 44 officers who volunteered for the training. Associations between officer status and sociodemographic variables, past exposure to and experience with mental illness issues, and empathy and psychological mindedness were examined.

The researchers found that, although self-selected CIT officers were more likely to have prior exposure to mental health issues and professionals, there were no differences between the three groups on measures of empathy or psychological mindedness. “Although there may be other justifiable reasons to argue for the importance of volunteering, characterological empathy and psychological mindedness do not appear to be greater among officers self-selecting in CIT training,” they said.

Compton and his colleagues have also characterized the psychiatric disposition of patients brought in by CIT-trained officers in a 2005 Community Mental Health Journal report. Select sociodemographic and clinical variables were abstracted from the medical records of 300 patients during an eight-month period and compared according to mode of referral: family members, non-CIT officers, and CIT-trained officers.

Differences across the three groups were found regarding race, whether the patient was held on the locked observation unit, severe agitation, recent substance abuse, global functioning, and unkempt or bizarre appearance, but there were no differences between patients referred by CIT-trained and non-CIT officers. “Trained officers do not have a narrower view of people in need of emergency services (i.e., bringing in more severely ill individuals), and they do not have a broader view (i.e., bringing in those not in need of emergency services),” the researchers concluded.