In 1987, a young man living in a public housing complex in Memphis, Tennessee, was threatening to stab himself and others with a knife. When police arrived, they tried to talk him down. But when the man refused to change his behavior, the police shot and fatally wounded him.
The incident provoked public uproar, partly for racial reasons — the young man was black and all of the police officers on the scene were white — but also because he had a history of mental illness. The outcry was the catalyst for a program that has since become a model for how officers can respond safely and effectively to calls involving people with serious mental illnesses such as schizophrenia, bipolar disorder and major depression.
"Sometimes the accident has to happen before the danger light goes on," as retired police Maj. Sam Cochran, the original coordinator of the Memphis team, puts it.
Today, there are about 2,800 of these programs — known as crisis intervention teams — nationwide. Tailored by each community to fit local needs, these teams unite the efforts of police officers, mental health educators and community advocates to resolve potentially violent situations in more positive ways. The concept has become so popular that in July, Sens. Kelly Ayotte (R-N.H.) and Mark Begich (D-Alaska) sponsored a bill that would offer $20 million in grants so that public safety professionals nationwide could take an eight-hour, evidence-based course with goals similar to those of crisis intervention teams.
"Our goal is to take individuals who don't really need to be in jail or even the court system, and get them into a treatment source," says Memphis psychologist Randy Dupont, PhD, the mental health lead for the original crisis intervention team program in Memphis, where the training has increased officers' confidence in their skills and knowledge about people with serious mental illnesses.
Research also shows that crisis intervention team training is effective. Two 2013 studies reported in Psychiatric Services by Michael T. Compton, MD, and colleagues found that Georgia police officers trained to work on crisis intervention teams were significantly more likely than untrained officers to gain mental health-related knowledge, attitudes and skills, to use verbal engagement or negotiation as their highest level of force and to refer people to mental health services rather than jail.
Likewise, a 2010 paper in Administration and Policy in Mental Health and Mental Health Services Researchopens in new window by Amy C. Watson, PhD, and colleagues found higher referral rates among Chicago police who took the training. Overall, police are responding to scenes more quickly and making fewer arrests and re-arrests, and fewer people are being hurt.
Understanding each other
From a national perspective, crisis intervention teams are an antidote to problems that have long plagued police departments, including a rudimentary understanding of mental illnesses and the insensitive responses that can result, says police psychologist Ellen Scrivner, PhD, who oversaw the Chicago Police Department's crisis intervention team when she served as deputy superintendent there from 2004–07. (Scrivner also is former deputy director of the National Institute of Justice, and part of the team that developed a new federal agency created by the Violent Crime Control and Law Enforcement Act of 1994, the Office of Community Oriented Policing Services.)
Crisis intervention teams and a growing number of programs like them "get out the message that most mentally ill people are not violent," Scrivner says. They also are highly compatible with the community policing movement. In fact, some crisis intervention team officers now work with families proactively, before there's a problem, she notes.
Crisis intervention teams work because of the synergy among the team members, says Cochran. As first responders, police work to de-escalate the situation and guide people into treatment rather than the criminal justice system. Psychologists and other mental health experts train police officershow to recognize and handle behavior related to mental illness. Community members provide suggestions and feedback on what works and what doesn't, as well as raise funds, among other roles.
And the team members learn from each other, says Scrivner.
"Psychologists get out of their counseling offices and out on the streets with the cops," she says. "The cops quit looking at things as either ‘an arrest' or a ‘not an arrest' situation. People in the community start saying, ‘Maybe the cops aren't as bad as we thought.' And police see the community as having a lot of information that's really very valuable to them."
A centerpiece of the effort is a 40-hour mental health training for police officers, about five times longer than standard police training on mental illness. One part of the training is didactic, where experts share information about mental illnesses, medications, behaviors and other relevant topics. Officers also learn de-escalation skills, such as how to move into a scene calmly and slowly, and how to effectively talk with and listen to the person in crisis.
In addition, the training includes small group meetings that bring together police, people with mental illnesses and their family members — conversations that give officers a more candid sense of the challenges these families face.
A central goal of the program is to address police stigma about mental illness, which in turn can improve community views about police, Cochran says. Police officers tend to enter police work with high ideals for serving and protecting the public. But that rosy view can quickly fade as officers face the realities of the job, and they can succumb to using rough or stereotyping language as a way of coping with a highly stressful job. Educating officers about mental illness helps to break this cycle by providing enough education for them to change their understanding of people with mental illness; meanwhile, pairing community partners with police helps civilians soften the view of police as tough-guy punishers, he says.
Model adaptations
Since their beginning, crisis intervention teams have assumed a variety of forms depending on their location and makeup. One of the most robust crisis intervention teams in the country is in central Virginia, which includes Charlottesville, Albemarle County and a large rural area. While the Memphis model suggests that at least a quarter of the patrol force in an urban area should be trained, the central Virginia team has trained more than 70 percent of its patrol officers and all of its emergency dispatchers, in part reflecting the need for as many responders as possible in less urban areas where there are fewer responders in general, says Tom von Hemert, the area coordinator.
The results there have been dramatic. From the time the program started in 2008 to 2012, the number of cases resolved on location rose from 550 to 700, the number of arrests decreased from 50 to 15, the average inmate population fell from 525 to 425, and both voluntary and involuntary commitment rates rose significantly, reflecting a greater proper use of mental health services. Now, von Hemert is applying for grants to fund a dedicated assessment center and a peer support specialist who could help people with mental illness who come to the center reconnect with the community.
Ohio has another strong program, with 86 out of 88 counties participating in crisis intervention teams, says Betsy Johnson, associate executive director of the National Alliance on Mental Illness (NAMI) of Ohio and a coordinator for the state's crisis intervention team. A unique component is peer assessment, where teams assess one another rather than relying on a state-wide oversight process, she says.
"It's a great concept because the peer assessors, who are members of local crisis intervention teams, can provide suggestions to other crisis intervention teams for improvement," she says. "But they can also see things other teams are doing well and implement those ideas in their own communities."
Some teams also are training both civilian police officers and police officers with the Veterans Health Administration on issues involving veterans with mental illness, including post-traumatic stress disorder, traumatic brain injury, readjustment stress and related substance use (see Intervening with vets). It's an important population to reach, says Tom Kirchberg, PhD, chief of psychology at the Memphis Veterans Affairs Medical Center, because without the right interventions, veterans can easily wind up in the criminal justice system.
Here to stay?
If all goes well, crisis intervention teams will continue to thrive and expand. They and similar programs are becoming such an integral part of communities that they aren't likely to be destroyed by shifting political winds, Scrivner and others say.
Two signs that this is the case: This year, police officers who went through crisis intervention training in New Mexico helped pass a $20 million bond issue for emergency psychiatric care to build a new facility and improve mental health services in the state.
The one gap in the program appears to be a continued shortage of funding for community mental health services, Dupont and others say. So while crisis intervention teams can deliver top-notch responses at crisis scenes, there aren't always enough resources to fully realize the vision of good long-term help.
That said, the programs are making a lasting impact on families and communities, says NAMI Ohio's Johnson, who has worked with crisis intervention teams in her state since 2006.
"What's exciting to me is that families are aware that these teams are out there," she says. "So they're far less reluctant to pick up the phone and call 911 if a loved one is in crisis. Before Ohio implemented these teams, they would have waited until they had no choice but to call. By then, it was often too late." n
Tori DeAngelis is a journalist in Syracuse, New York.
