Outcomes of Police Contacts with Persons with Mental Illness: The impact of CIT

The Crisis intervention team model (CIT) is possibly the most well known and widely adopted model to improve police response to persons with mental illness. A primary goal of CIT programs is to divert individuals with mental illness from the criminal justice system to mental health services. In this paper we examine the effectiveness of fielding CIT trained and supported officers for influencing call outcomes using data from patrol officers (n = 112) in four Chicago Police districts. Results from regression analysis indicate that CIT certified officers directed a greater proportion of persons with mental illness to mental health services than their Non-CIT certified peers. CIT did not have an immediate effect on arrest. Moderator analysis indicates that CIT had its biggest effect on increasing direction to services and decreasing "contact only" among officers who have a positive view of mental health services and who know a person with mental illness in their personal life. Additional moderators of the CIT effect on call outcomes include level of resistance and the presence of a weapon. Findings from this study have important implications for policy, practice and future research.     

Development and Validation of the Mental Health Attitude Survey for Police

Police officers often lack sufficient mental health training and knowledge of mental illness to manage the risks associated with emotionally disturbed person (EDP) encounters. Still, it is not clear how much mental health training police officers actually need and, to date, there are no measures for police departments to use to determine officer attitudes toward dealing with EDPs. This led to the development of the Mental Health Attitude Survey for Police (MHASP), a modification and compilation of previously developed and newly developed items, which can be used to measure the effectiveness of mental health crisis training curricula in improving police attitudes toward persons with mental illnesses. A sample of 412 police officers from a major city police department in the northeast anonymously completed the MHASP. The results provide good evidence that the MHASP is a reliable and initially validated measure of police attitudes toward persons with mental illnesses.     

Crisis intervention team training for police officers responding to mental disturbance calls

OBJECTIVES: In recognition of the fact that police are often the first responders for individuals who are experiencing a mental illness crisis, police departments nationally are incorporating specialized training for officers in collaboration with local mental health systems. This study examined police dispatch data before and after implementation of a crisis intervention team (CIT) program to assess the effect of the training on officers' disposition of calls. METHODS: The authors analyzed police dispatch logs for two years before and four years after implementation of the CIT program in Akron, Ohio, to determine monthly average rates of mental disturbance calls compared with the overall rate of calls to the police, disposition of mental disturbance calls by time and training, and the effects of techniques on voluntariness of disposition. RESULTS: Since the training program was implemented, there has been an increase in the number and proportion of calls involving possible mental illness, an increased rate of transport by CIT-trained officers of persons experiencing mental illness crises to emergency treatment facilities, an increase in transport on a voluntary status, and no significant changes in the rate of arrests by time or training. CONCLUSIONS: The results of this study suggest that a CIT partnership between the police department, the mental health system, consumers of services, and their family members can help in efforts to assist persons who are experiencing a mental illness crisis to gain access to the treatment system, where such individuals most often are best served.     

Police responses to persons with mental illness: does the label matter?

With the movement of persons with mental illness out of hospitals and into the community, the frequency of contact between police officers and such persons, in crisis or otherwise, has increased significantly. How police respond in these situations has important consequences for the subject, police officers, and the community. Officers (n = 554) from police departments in a major metropolitan area participated in a vignette experiment that examined how information that a subject has a mental illness influences the way police officers respond in several types of situations. Results indicate that officers are less likely to take action based on information provided by victims and witnesses with mental illness. No differences were found in response to suspects with or without a mental illness. The effects of officer characteristics and perceptions of the subject on responses to the vignettes were also examined. Findings suggest several directions for training and future research.     

On the Role of Correctional Officers in Prison Mental Health

This article discusses the role of correctional line staff in treatment of prison inmates with serious mental illness. The authors assert that many roles and duties traditionally attributed to clinicians can and often should be performed not only by mental health professionals, but by line staff such as correctional officers and nurses. Moreover, the optimal climate for effective treatment is one in which mental health professionals and line staff work collaboratively, especially since line staff alone are in contact with inmates 24 hours per day. The specific activities which comprise mental health treatment in prison are described as: 1) counseling and psychotherapy-talking with inmates, 2) consultation-talking about inmates, 3) special housing, activities, and behavioral programs, and 4) medication. Case examples demonstrate how correctional officers, nurses, and other line staff perform each of these activities. Recognition and nurturance of these activities will improve the quality of services and reduce stress on staff and inmates alike. Consultation with line staff, joint training, and use of multi-disciplinary treatment teams are advocated as methods of reaching these goals.     

Mentally Ill Persons in the Criminal Justice System: Some Perspectives

There is an increasing number of severely mentally ill persons in the criminal justice system. This article first discusses the criminalization of persons with severe mental illness and its causes, the role of the police and mental health, and the treatment of mentally ill offenders and its difficulties. The authors then offer recommendations to reduce criminalization by increased coordination between police and mental health professionals, to increase mental health training for police officers, to enhance mental health services after arrest, and to develop more and better community treatment of mentally ill offenders. The necessary components of such treatment are having a treatment philosophy of both theory and practice; having clear goals of treatment; establishing a close liaison between treatment staff and the justice system; understanding the need for structure; having a focus on managing violence; and appreciating the crucial role of case management, appropriate living arrangements, and the role of family members.     

Mental health training for law enforcement professionals

The purpose of this pilot study was to determine topics of interest and preferred modalities of training for police officers in their work with persons with mental illness. Police officers across Massachusetts attending in-service mental health training were asked to rate the importance of potential mental health topics and the effectiveness of potential training modalities on a Likert-type scale. Additional data collected included the officer's experience, level of education, motivation for attendance, previous attendance of post-academy mental health training, and preferences for length, frequency, training site, and trainer qualifications. A t test was used to determine if there were significant differences (p < .05) between those who volunteered and those who were mandated to attend the training. Repeated-measures ANOVAs were used to determine if there were significant differences (p < .05) between mental health topics and lecture formats and to determine the effect of education and experience on the results. Although all topics suggested were rated, primarily, as fairly important, the topics of Dangerousness, Suicide by Cop, Decreasing Suicide Risk, Mental Health Law, and Your Potential Liability for Bad Outcomes were given the highest ratings. Role-playing was rated significantly lower than other training modalities, while Videos and Small Group Discussion had the highest mean scores. Level of prior education had no significant effect on the ratings, but officers with more experience rated the importance of mental illness as a training topic significantly higher than officers with less experience. This survey suggests that police officers are interested in learning more about working with persons with mental illness and view it as an important aspect of the job.     

Active ingredients in anti-stigma programmes in mental health

This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14–15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on ‘what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma.     

The Impact of Integrating Crisis Teams into Community Mental Health Services on Emergency Department and Inpatient Demand

This investigation focused on the impact of integrating crisis team members into community mental health services on emergency department and adult mental health inpatient unit demand within an Australian public health service. Mixed methods were used including (a) the comparison of service use data with that of two other comparable services (both of which had community-based crisis teams), (b) surveys of (i) patients and carers and (ii) staff, and (c) focus groups with staff. The numbers of emergency department presentations with mental health conditions and adult mental health inpatient separations increased 13.9 and 5.7 %, respectively, from FY2006/07 to FY2012/13. Between the three services, there were minimal differences in the percentages of presentations with mental health conditions, the distribution of mental health presentations across a 24-h period, and the triage categories assigned to these patients. Survey participants reported that patients used the emergency department due to the urgency of situations, perceptions that gaining access to mental health services would take less time, and the unavailability of mental health services when help is needed. Staff identified several issues (e.g. inappropriate referrals) that may be unnecessary in increasing emergency department demand. The integration of crisis team members into community mental health services does not seem to have produced an increase in emergency department admissions or inpatient separations beyond what might be expected from population growth. The potential may exist, however, to reduce emergency department admissions through addressing the issue of inappropriate referrals.     

Interviewing persons with mental illness charged with murder or attempted murder: a retrospective review of police interviews

Individuals with a mental illness may be particularly vulnerable during police interviews. Assessing fitness for police interview is vital for ensuring procedural fairness. This article reports the findings of a retrospective review of 31 police interviews of mentally ill persons charged with murder (n?=?18) or attempted murder (n?=?13) who appeared before the Queensland Mental Health Court. Police interviews were conducted for all murder and 50% of attempted murder cases. Possible or overt mental illness symptoms were present in all interviews. Symptoms of mental illness were pervasive in 36.7% of interviews, intermittent in 43.3% of interviews and seldom in 20% of interviews. Support persons were present for 9.7% of interviews, and legal representation was not present for any interview. These findings highlight the need to enhance access to support persons during interviews. Intersectoral collaboration between mental health services, forensic medical officers, police, public guardians and the legal sector is needed.     

Limitations of System Integration in Providing Employment Services for Persons with Mental Illness

This study assessed the influence of service systems integration on employment outcomes for persons with mental illness. A survey was sent to all 125 key program staff that worked for community mental health treatment agencies or vocational rehabilitation agencies. The survey found that referral and employment rates were low; but that these rates were related to characteristics of the interagency systems integration. Community mental health staff referred 448 individuals for employment services. Staff from vocational rehabilitation agencies accepted only 26% of these referrals and found work for just 11%; 7% were employed six months later. Also, 39% of respondents reported that the linkage agreement between their agencies was never established. This study suggests the need for more effective strategies for integrating mental health treatment and vocational rehabilitation systems.A version of this paper was presented at the Academy/Health annual conference in San Diego, June 8, 2004.     

Co-location of Health Care for Adults with Serious Mental Illness and HIV Infection

This study describes persons with serious mental illness and comorbid HIV infection and examines the effect of co-location of mental health and HIV care on satisfaction, service utilization, and appropriateness of care. One hundred and eighteen subjects completed interviews and gave blood samples; medical records were abstracted. Most reported few barriers to care and satisfaction with mental health and HIV treatment. Co-location of mental health and HIV care did not influence satisfaction with care, utilization of services, or appropriateness of care. This report challenges the notion that persons with serious mental illnesses receive inadequate health care and that they have minimal capacity for illness management. These subjects may be benefiting from increased funding for, and attention to, persons with HIV infection.     

Active ingredients in anti-stigma programmes in mental health

This paper draws upon a review of the relevant literature and the results of the recent Mental Health Awareness in Action (MHAA) programme in England to discuss the current evidence base on the active ingredients in effective anti-stigma interventions in mental health. The MHAA Programme delivered educational interventions to 109 police officers, 78 adults from different community groups whose working lives involved supporting people with mental health problems but who had received no mental health training and 472 schools students aged 14-15. Each adult target group received two intervention sessions lasting two hours. The two school lessons were 50 minutes each. Knowledge, attitudes and behavioural intent were assessed at baseline and follow-up. In addition focus groups were held with mental health service users to explore the impact of stigma on their lives and facilitators of educational workshops were interviewed to provide expert opinion on 'what works' to reduce psychiatric stigma. Personal contact was predictive of positive changes in knowledge and attitudes for the school students but not the police officers or community adult group. The key active ingredient identified by all intervention groups and workshop facilitators were the testimonies of service users. The statements of service users (consumers) about their experience of mental health problems and of their contact with a range of services had the greatest and most lasting impact on the target audiences in terms of reducing mental health stigma.     

Crisis Intervention Team (CIT) Programs in Rural Communities: A Focus Group Study

The Crisis Intervention Teams model (CIT) was originally developed as an urban model for police officers responding to calls about persons experiencing a mental illness crisis. Literature suggests that there is reason to believe that there may be unique challenges to adapting this model in rural settings. This study attempts to better understand these unique challenges. Thematic analysis of focus group interviews revealed that there were both external and internal barriers to developing CIT in their respective communities. Some of these barriers were a consequence of working in small communities and working within small police departments. Participants actively overcame these barriers through the realization that CIT was needed in their community, through collaborative efforts across disciplines, and through the involvement of mental health advocacy groups. These results indicate that CIT can be successfully implemented in rural communities.     

Linkage agreements between mental health and law enforcement agencies: Managing suicidal persons

Linkage agreements have been developed between community mental health and law enforcement agencies to coordinate management of mental health emergencies. This paper analyzes one such linkage and the ramifications for assisting individuals experiencing suicidal episodes. The results indicate that police officers are in fact called upon to manage persons threatening suicide and need further training to do so. Further, police officers do contact mental health providers for assistance and linkage agreements are seen as an asset by police.This research was funded by a grant from the University of Texas Pan-American Faculty Research Council. 1990–1991.     

A front line police perspective of mental health issues and services

Background Changes in mental health service provision in most western countries have been associated with an increasing role of the police in the community management of people with mental health problems, but little is known about how the police perceive this in the UK. Objectives To investigate police officers' views on their roles in dealings with people with mental health problems and with mental health services. Methods Nine in‐depth semi‐structured interviews were conducted with front line police officers. These interviews were analysed for recurrent themes using interpretative phenomenological analysis. Results The recurrent themes identified were: emotional aspects of dealing with people with mental health problems and with services, impact of incidents on police resources and on people with mental health problems, success through collaborative working with health services and failure in its absence. Conclusions Police officers' experiences of work with people with mental disorder in the community in Scotland had much in common with those previously reported in the USA and in Australia. Development of more collaborative approaches and mutual respect between the police and mental health service providers would resolve many of the currently perceived difficulties. Copyright © 2010 John Wiley & Sons, Ltd.     

Review of Community Pharmacy Staff Educational Needs for Supporting Mental Health Consumers and Carers

Development of a mental health education package for community pharmacy staff should be informed by mental health consumers/carers’ needs, expectations and experiences, and staff knowledge, skills and attitudes. This review (1) explored research on community pharmacy practice and service provision for mental health consumers/carers, and (2) identified validated methods for assessing staff knowledge, skills and attitudes about mental illness to inform the development of a training questionnaire. A literature scan using key words knowledge, skills, attitudes, and beliefs combined with community pharmacy, pharmacist, and pharmacy support staff, and mental illness, depression, anxiety was conducted. A small number of studies were found that used reliable methods to assess pharmacists’ training needs regarding mental illness and treatment options. There was little published specifically in relation to depression and anxiety in community pharmacy practice. No studies assessed the training needs of pharmacy support staff. A systematic analysis of pharmacy staff learning needs is warranted.     

The impact of killing and injuring others on mental health symptoms among police officers

This study examined the relationship between killing or seriously injuring someone in the line of duty and mental health symptoms in a sample of police officers (N = 400) who were first assessed during academy training and at five additional time points over three years. We found that nearly 10% of police officers reported having to kill or seriously injure someone in the line of duty in the first three years of police service. After controlling for demographics and exposure to life threat, killing or seriously injuring someone in the line of duty was significantly associated with PTSD symptoms (p < .01) and marginally associated with depression symptoms (p = .06). These results highlight the potential mental health impact of killing or seriously injuring someone in the line of duty. Greater attention to mental health services following these types of exposures can serve as a preventative measure for police officers who have been negatively impacted.     

Mental health service delivery to older people in New South Wales: perceptions of aged care, adult mental health and mental health services for older people

OBJECTIVE: To compare the perceptions of aged care services, adult mental health services and mental health services for older people regarding aspects of mental health service delivery for older people in New South Wales, Australia. METHOD: The NSW Branch of the Faculty of Psychiatry of Old Age in association with the NSW Centre for Mental Health, sent a postal survey to all aged care services, adult mental health services and mental health services for older people in NSW. The survey canvassed issues ranging across service profiles, regional variations, availability of resources, processes of care, views on working relationships between services, difficulties and gaps experienced, and ways to improve co-ordination and service delivery. Clinical issues such as the management and practice of psychiatric disorders of old age, educational/training requirements and skill and experience in working with older people were explored. RESULTS: An overall response rate of 86% was achieved, including 95% from aged care services (n = 58), 74% from adult mental health services (n = 62) and 90% from mental health services for older people (n = 20). Only 59% of aged care services and adult mental health services considered that their local mental health services for older people provided an adequate service; resource and budget limitations were portrayed as the main constraint. Mental health services for older people varied widely in structure, settings and activities undertaken. Access to mental health beds for older people was also variable, and alongside staffing levels was considered problematic. Lack of staff training and/or inexperience in psychogeriatrics posed a challenge for aged care services and adult mental health services. CONCLUSION: Relationships between aged care services, adult mental health services and mental health services for older people are affected by lack of access to psychogeriatric staff, resource limitations of mental health services for older people, and inadequate liaison and support between the service types. Joint case conferences, education, increased funding of mental health services for older people, and cross referrals were considered ways to address these issues.     

Defying Negative Expectations: Dimensions of Fair and Respectful Treatment by Police Officers as Perceived by People with Mental Illness

Programs to improve police interactions with persons with mental illness are being initiated across the country. In order to assess the impact of such interventions with this population, we must first understand the dimensions of how police encounters are experienced by consumers themselves. Using procedural justice theory as a sensitizing framework, we used in-depth semi-structured interviews to explore the experiences of twenty persons with mental illness in 67 encounters with police. While participants came into contact with police in a variety of ways, two main themes emerged. First, they feel vulnerable and fearful of police, and second, the way police treated them mattered. Findings elaborate on dimensions of procedural justice theory and are informative for police practice and mental health services.