A Crisis Intervention Team (CIT) is a police mental health collaborative program found in North America. [1] The term "CIT" is often used to describe both a program and a training in law enforcement to help guide interactions between law enforcement and those living with a mental illness.
The National Alliance on Mental Illness (NAMI) Crisis Intervention Team (CIT) programs are local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crisis. CIT programs are built on strong partnerships between law enforcement, mental health provider agencies, and individuals and families affected by mental illness." [2]
Mental health contacts and intervention by law enforcement became part of the profession with the deinstitutionalization of nonviolent mentally ill patients in the 1960s. The goal was to allow people receiving treatment in an institution to continue to receive the treatment but from community service agencies. The money saved by hospital closing was to be transferred to outpatient community programs.
The money intended for outpatient services never found its way to the community. Funding for outpatient treatment services and programs are still lacking in most areas of the United States. This left a gap for people who were in need of services. Without the assistance many people stop their treatment programs; which resulted in many people becoming unstable while living in the community, with their families who were ill-equipped to be caregivers.
When people living with the illness became psychotic or had poor quality of life in communities, the police became the go to resource for helping. Law enforcement has always been there to serve the most vulnerable in their community, which historically was viewed as victims of crime. With the lack of resources and treatment for people with mental illness they became the most vulnerable in many communities leading officers to become front line mental health workers.
In September 1987, Memphis, TN, police responded to a 911 call involving a man with a history of mental illness who was cutting himself with a knife and threatening suicide. When officers responded to the location they ordered the man to drop the knife. The man became more upset and ran toward the officers with the knife still in his hand. Officers then discharged their firearms killing the man. [3]
Officers were trained to use deadly force when they perceive their own or someone else's life to be in grave danger. This incident was criticized because the perception on the call was the only life in danger was the man who wanted to kill himself. This occurred during a time of racial tension in Memphis and the man was African-American while both officers were white. This incident was the catalyst for the creation of the Crisis Intervention Team (CIT) in Memphis.
The Memphis Police Department joined in partnership with the Memphis Chapter of the National Alliance on Mental Illness (NAMI), mental health providers, and two universities (University of Memphis and University of Tennessee) in organizing, training, and implementing a specialized unit. This new alliance was established to develop a more intelligent, understandable, and safe approach to mental health crisis events. The community effort was the genesis of the Memphis Police Department's Crisis Intervention Team.
The Memphis CIT program has achieved remarkable success, in large part because it has remained a true community partnership. Today, the so-called "Memphis Model" has been adopted by more than 2,700 communities in the U.S. including other countries.
The University of Memphis School of Urban Affairs and Public Policy Department of Criminology and Criminal Justice CIT Center [4] released a paper outlining central components of CIT in 2007. [5] The elements of CIT programs identified are:
Ongoing Elements
Operational Elements
Sustaining Elements
In the state of Oregon, CIT programs were implemented after the death of James Chasse, who was beaten and repeatedly tased by three Portland police officers in 2006. [6] Chasse, who had schizophrenia, sustained 16 broken ribs, a broken shoulder and sternum, and major internal injuries. He was taken to the city jail, where the medical staff refused to admit him and ordered that he be taken to a hospital. But he died en route. The three officers were never indicted for their part in his death. Medics later testified that his broken ribs were most likely due to the emergency trauma care (CPR) he received.[ citation needed ]
Chasse's death prompted an outcry in the news media, in response to which Portland mayor Tom Potter instituted a CIT program. Other cities and counties in Oregon followed suit. [7]
Starting in late 2011, a group of Texas CIT officers met in Austin, Texas, to lay the foundation for Texas' first CIT Officer's Association. The association's goal is to promote mental health education as it pertains to law enforcement's interaction and care for the mentally ill. The association will also host an annual conference where stakeholders can discuss new options for better practices in the field. The Association launched its website in 2012. [8]
In Albuquerque, NM, the police department began a Crisis Intervention Team program in 1996 after 6 people were killed in crisis related police shootings between 1994 and 1995. The increase was associated with victim participant homicides or suicide by cop. Sergeant William Pettit went to the Memphis Police Department to understand a Crisis Intervention Team model in 1988. Sgt. Pettit was instructed about the Memphis program and implemented elements in order to create a CIT program within the Albuquerque Police Department. [9]
Albuquerque was hit again with community tragedies involving law enforcement interaction with people living with a mental illness that sparked an investigation by the Department of Justice (DOJ) in 2014. [10] The community voiced their concerns and the investigation by the DOJ also noted, "fatal confrontations with individuals experiencing mental health crises continue to cause significant public concern over the department's ability and willingness to consider the safety and well-being of the individuals in distress." The finding letter also stated, "A significant amount of the force we reviewed was used against persons with mental illness and in crisis." [11] During this investigation the shooting of James Boyd occurred.
The findings letter and outcry from the community ended in a court appointed settlement agreement with the Department of Justice. The settlement agreement determined that all officers will be trained in CIT and that 40% of field officer would receive additional specialized training in interactions with people experiencing crisis. The agreement also stated that the department's full time crisis intervention unit be staffed with 12 full time detectives. [12]
Some cities in Canada have implemented Crisis Intervention Teams based on three models. [13] The Mobile Crisis Intervention Team (MCIT) model pairs a police officer with a nurse and responds to calls after first-responders have rendered or as first-responders render the scene safe. [13] [14] [15] The Mobile Crisis Rapid Response Team (RRT) model responds directly to calls relating to people in crisis. [14] [16] The Crisis Outreach and Support Team (COAST) model sends teams by appointment through a hotline and often provides social services. [14] [17] Cities in Canada vary on which models they choose to implement. [13]
The Toronto Police Service MCIT has existed since the year 2000. [15] However, the MCIT unit received significant attention after the shooting death of immigrant, Sammy Yatim, when a Toronto police officer intervened aggressively against Yatim who was holding a knife aboard a streetcar. [13] The expansion of the MCIT unit was recommended in a subsequent coroner's inquest into police shootings of suspects with edged weapons. [18] Toronto Police MCIT teams are composed of mental health nurses from various local hospitals paired with a police officer. The team responds to calls as secondary responders. [15]
The Hamilton Police Service is the first police service in Canada to implement all three models of crisis intervention programs. [14] [13] The Crisis Response Unit implements the MCIT and MCRRT models as the Mobile Rapid Response Team, while the COAST model is implemented by the COAST and Social Navigator teams. [19] It is claimed that following the implementation of the COAST program, arrest rates for persons in crisis fell from 66% to 25% [20] and on average, police officers saved 580 hours per year. [14]
The Vancouver Police Department has implemented the MCIT model using Car 87 since 1978. [21] [13] The COAST model is implemented through both the Assertive Community Treatment Team (ACT) and the Assertive Outreach Team (AOT). The ACT is composed primarily of mental health professionals, and provides social services for patients with high-risk or long-term mental health issues. The AOT provides support to patients with mental health issues as they leave detention in hospital or jail. [22]
The National Alliance on Mental Illness (NAMI) is a United States-based nonprofit organization originally founded as a grassroots group by family members of people diagnosed with mental illness. NAMI identifies its mission as "providing advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives" and its vision as "a world where all people affected by mental illness live healthy, fulfilling lives supported by a community that cares". NAMI offers classes and trainings for people living with mental illnesses, their families, community members, and professionals, including what is termed psychoeducation, or education about mental illness. NAMI holds regular events which combine fundraising for the organization and education, including Mental Illness Awareness Week and NAMIWalks.
De-escalation refers to the methods and actions taken to decrease the severity of a conflict, whether of physical, verbal or another nature. It is the opposite of escalation. De-escalation may also refer to approaches in conflict resolution, by which specific measures are taken to avoid behaviours that escalate conflict. De-escalation can be modelled with game theory.
In November 2004, voters in the U.S. state of California passed Proposition 63, the Mental Health Services Act (MHSA), which has been designed to expand and transform California's county mental health service systems. The MHSA is funded by imposing an additional one percent tax on individual, but not corporate, taxable income in excess of one million dollars. In becoming law in January 2005, the MHSA represents the latest in a Californian legislative movement, begun in the 1990s, to provide better coordinated and more comprehensive care to those with serious mental illness, particularly in underserved populations. Its claim of successes thus far, such as with the development of innovative and integrated Full Service Partnerships (FSPs), are not without detractors who highlight many problems but especially a lack of oversight, large amount of unspent funds, poor transparency, lack of engagement in some communities, and a lack of adherence to required reporting as challenges MHSA implementation must overcome to fulfill the law's widely touted potential.
Law enforcement in Canada is the responsibility of police services, special constabularies, and civil law enforcement agencies, which are operated by every level of government, some private and Crown corporations, and First Nations. In contrast to the United States or Mexico, and with the exception of the Unité permanente anticorruption in Quebec and the Organized Crime Agency of British Columbia, there are no organizations dedicated exclusively to the investigation of criminal activity in Canada. Criminal investigations are instead conducted by police services, which maintain specialized criminal investigation units in addition to their mandate for emergency response and general community safety.
Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. ACT teams serve individuals who have been diagnosed with serious and persistent forms of mental illness, predominantly but not exclusively the schizophrenia spectrum disorders. ACT service recipients may also have diagnostic profiles that include features typically found in other DSM-5 categories. Many have histories of frequent psychiatric hospitalization, substance abuse, victimization and trauma, arrests and incarceration, homelessness, and additional significant challenges. The symptoms and complications of their mental illnesses have led to serious functioning difficulties in several areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness. By the time they start receiving ACT services, they are likely to have experienced failure, discrimination, and stigmatization, and their hope for the future is likely to be quite low.
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is an agency of the Government of Oklahoma responsible for providing public health services relating to mental illness and substance abuse.
The Canadian Mental Health Association (CMHA) is a Canadian non-profit mental health organization that focuses on resources, programs and advocacy. It was founded on April 22, 1918, by Clarence M. Hincks and Clifford W. Beers. Originally named the Canadian National Committee for Mental Hygiene, it is one of the largest and oldest voluntary health organizations operating in Canada.
Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis.
James Philip Chasse, Jr. was an American from Portland, Oregon. In 2006 his death while in the custody of Portland law enforcement officers caused an outcry over civil rights and an examination of the lack of mental health crisis management training given to Portland police officers. At the time of his death, he was living in an apartment in downtown Portland and had been diagnosed with schizophrenia.
The Mental Evaluation Unit (MEU), including the Systemwide Mental Assessment Response Team (SMART), is the police crisis intervention team of the Los Angeles Police Department (LAPD), working with people suspected of having a mental illness. The MEU seeks to de-escalate situations where mentally-ill suspects are believed be involved.
The Albuquerque Police Department (APD) is the municipal law enforcement agency of Albuquerque, New Mexico. It is the largest police force in the state, with approximately 1,000 sworn officers in 2022.
The Pima County Sheriff's Department (PCSD) is an American law enforcement agency that serves the unincorporated areas of Pima County, Arizona. It serves the seventh largest county in the nation. It operates six district offices and three smaller satellite offices. The Corrections Bureau has four facilities which houses on average 1,850 inmates per day.
United States v. City of Portland was a lawsuit filed by the United States Department of Justice against the City of Portland, Oregon on December 17, 2012, alleging a pattern or practice of unconstitutional use of force by the Portland Police Bureau against individuals with actual or perceived mental illness.
Morton Bard was an American psychologist, known for the research he undertook on the psychology of crime victims. He was a one-time member of the New York Police Department, a psychologist, and a professor who studied the reactions of crime victims.
The Sequential Intercept Model clarifies five points at which standard processing of crimes can be intervened with community-based actions, so that individuals with mental and psychiatric disorders would not have to further penetrate the criminal justice system. By understanding and using the model, communities can develop a series of strategies to increase diversion of individuals with mental disorder from the criminal justice system and to help them receive proper community-based treatments.
Michael Louis Chapman is a law enforcement executive who is the current sheriff of Loudoun County, Virginia and administrator of the Loudoun County Sheriff's Office.
CAHOOTS is a mental-health-crisis intervention program in Eugene, Oregon, which has handled some lower-risk emergency calls involving mental illness and homelessness since 1989. This makes it the earliest, or one of the earliest, Mobile Crisis Teams.
A wellness check is an in-person visit from one or more law enforcement officers, especially in response to a request from a friend or family member who is concerned about the person's wellbeing.
Behavioral Crisis Response (BCR) is a behavioral health emergency response program in Minneapolis, Minnesota. This program dispatches unarmed mental health professionals to 911 calls. It is run by Canopy Mental Health and Consulting, a Richfield, Minnesota-based company in mental health services, in collaboration with the Office of Community Safety.
The Toronto Community Crisis Service (TCCS) is the non-police crisis intervention pilot program operated by the City of Toronto. The program runs in four areas of Toronto and partners with local community health agencies, which provide crisis workers. The program is integrated with the local 2-1-1 and 9-1-1 call centres.