III. Police and the Mentally Ill
To understand this phenomenon, it is important to explain the process by which many mentally ill people were ultimately imprisoned. After being placed under community supervision, many persons with mental illness were left to their own devices for obtaining and properly taking their prescribed medication. One of the major assumptions that policymakers made during the transition was that, with better medication for mental illness, mentally ill persons would be medication compliant. This assumption proved to be false; people with mental illness often failed to comply with their medication and then violated the law or some social precedent. This violation often resulted in the commission of a crime or homelessness. Many of the severely mentally ill people who were released into the community through deinstitutionalization are now part of the 600,000 people in America who are homeless. Of these, it is believed that at least one third are mentally ill (U.S. Department of Health and Human Services, 1999). The most common offenses committed by mentally ill persons are assault, theft, robbery, shoplifting, alcohol or drug-related charges, and trespassing (Robertson, Pearson, & Gibb, 1996). Thus, law enforcement has played a major role in responding to and resolving these issues.
A study conducted by the Consensus Project and published in 2002 (Council of State Governments, 2002) indicated that in “police departments of U.S. cities with a population greater than 100,000, approximately 7 percent of all police contacts, both investigations and complaints, involved a person believed to have a mental illness” (p. 21). Further exemplifying the problem, the study also made the following observation:
During the year 2000, law enforcement officers in Florida transported more than 40,000 people with mental illness for involuntary 72 hour psychiatric examinations under the Baker Act. This exceeds the number of arrests in the state during 2000 for either aggravated assault (39,120) or burglary (26,087). (p. 25)
In 1998, New York City police officers transported 24,787 emotionally disturbed persons to hospitals for psychiatric evaluations, up from 1,000 in 1976 (Bumiller, 1999). Law enforcement officers’ safety is compromised when they are handling incidents involving mentally ill offenders. In 1998, mentally ill offenders killed law enforcement officers at a rate 5.5 times greater than that of the rest of the population (http://www.psychlaw.org/). These facts make it apparent that law enforcement is the initial point of governmental contact that mentally ill offenders will have.
To more effectively handle the increased contact between law enforcement personnel and mentally ill people, U.S. law enforcement agencies have implemented numerous programs. The most effective are training programs designed to equip officers with the resources needed to effectively and appropriately deal with the mentally ill. Among these programs is the Crisis Intervention Team (CIT), one of the most successful. Originating in Memphis, Tennessee, in 1988, it is often referred to as the Memphis Model. According to Dr. Mark Munetz (personal communication, February 1, 2008),
The first CIT program began in Memphis, Tennessee. In 1987, 27-year-old Joseph Dewayne Robinson was shot and killed during an incident with the Memphis Police Department. This shooting outraged the community. From this community crisis emerged in 1988 a new way of doing business for both the police and the mental health community in Memphis, based on a collaborative effort designed to help police officers identify and deal with mentally ill people.
The premise of the CIT program is to improve law enforcement officers’ response to the mentally ill. It is a law enforcement–based specialized response model. Until the CIT was developed, most basic law enforcement training referred to mentally ill individuals as emotionally disturbed people (EDP for short) and gave very basic instruction on the dangers officers face when encountering such individuals. This instruction ranged from describing the mentally ill as unpredictable to delineations of the proper distance an officer should maintain from such an individual. There was no training on how to effectively deescalate a situation involving a mentally ill offender. Thus, the 1987 Memphis case just described was often the norm rather than the exception. As CIT programs have become more widespread, these incidents have declined in number.
The CIT program relies on 10 elements to allow law enforcement officers to effectively and efficiently deal with mentally ill offenders (Schwarzfeld, Reuland, & Plotkin, 2008). As with any multidimensional program, collaboration plays a very important part. The CIT program relies on ensuring the appropriate response from incident inception to incident disposition and thus involves all components of law enforcement. The following is a list of the 10 components Schwarzfeld et al. (2008) recommended:
- Collaborative Planning and Implementation
- Program Design
- Specialized Training
- Call-Taker and Dispatcher Protocols
- Stabilization, Observation, and Disposition
- Transportation and Custodial Transfer
- Information Exchange and Confidentiality
- Treatment, Supports, and Services
- Organizational Support
- Program Evaluation and Sustainability
The key to a successful CIT program is the collaboration among agencies involved with law enforcement; health care; mental health; corrections; courts; advocacy groups; and, perhaps most important, funding agencies and sources. Another key component is providing first responders— both dispatchers and law enforcement officers—with specialized training. That training typically includes subjects such as mental illnesses, signs and symptoms of mental illnesses, de-escalation techniques, stabilization, disposition options, community resources, and legal issues. The most important part of the program is the focus on proper identification, intervention, and referral to the appropriate community resources.
The CIT program in Memphis provides 40 hours of specialized training for law enforcement officers, encompassing much of the aforementioned information. According to Dupont, Cochran, and Bush, (1999), the Memphis CIT program reduced officer injuries sustained during mental disturbance calls by over 80%. The Memphis CIT program has also proven to be very cost-effective in that it has reduced the number of rearrests among mentally ill offenders. In addition, officers trained in the CIT program are 25% more likely to transport mentally ill offenders to a psychiatric or community mental health facility instead of to jail (Teller, Munetz, Gil, & Ritter, 2006).
The CIT program is one of the most effective means of helping law enforcement personnel effectively handle persons with mental illness. According to the Bureau of Justice Statistics (2006), there are more than 400 CIT programs operating in the United States. The CIT program has been successful in both metropolitan and rural areas as well.