(MEMPHIS, Tenn.) – It was a situation many police departments have had to deal with.
In 1987, Memphis officers responded to a call about a man acting bizarrely. The confrontation that followed ended when he was shot dead. There was a community outcry about the killing of someone whose chief crime was that he was mentally ill and not getting the help that he needed.
The usual response is to call for more training for police officers. But Memphis officials discovered that the police department already had a better training program on mental illness than most – so good that other departments turned to the city for assistance. Clearly, something more was needed.
The Police Department joined forces with the local chapter of the National Association for the Mentally Ill and doctors from local psychiatric facilities to look for a new approach. In 1988, Memphis created its Crisis Intervention Team, the first in the country. Now, 195 members of the city’s 900-officer uniformed patrol division are trained CIT officers. About 20 cities across the country have adopted the program, and 30 or 40 are preparing to do so.
“In order to really effectively make some community changes, you have to have more than just one component,” said Major Sam Cochran, who heads the Memphis CIT program.
In the United States, police departments and departments of corrections have become the major provider of housing and services for the mentally ill. Ron Honberg, NAMI’s legal director, said that across the country there are five times as many people with psychiatric problems in jails and prisons as in hospitals.
”It’s a shame that we are making it too easy to access mental health services through the criminal justice system,” Cochran said.
Honberg believes that CIT programs are one of the best ways of breaking that cycle. A number of other approaches are being tried, including mental health courts and drug courts that emphasize treatment.
In Memphis, the police department and the mental health system had to change old habits.
Cochran said the department had to give up the belief that patrol officers should be generalist professionals, capable of responding to any situation they might encounter. Officers trained to respond to any threat or show of force with greater force had to learn to back off..
CIT officers are volunteers who are screened for judgment and maturity, Cochran said. They must be leaders because the CIT officer responding to a call involving someone who appears to be mentally ill is in charge at the scene.
CIT officers are assigned to all shifts and all precincts, and dispatchers can send one to another precinct if needed. The average response time is about five minutes.
Dr. Randy Dupont, head of the psychiatric emergency service at the University of Tennessee Regional Medical Center, said that medical workers also had to learn to work with the police. In many cities, police officers will charge a mentally ill person with a crime and head for the jail because they do not want to spend hours waiting in an emergency room while a patient is being evaluated. In Memphis, officers can now be back on the street 15 minutes to half an hour after they bring a patient in.
“We’re not using police officers as baby sitters,” Dupont said.
Training continues to be important. CIT officers receive 40 hours of instruction when they are selected, and several more hours of training every year. They learn how to recognize the different types of mental illness and are trained in “verbal de-escalation skills,” Cochran said.
All officers get some training in recognizing mental illness, and dispatchers learn what questions to ask when they get a call that appears to involve a psychiatric crisis. But Cochran and Dupont believe that young recruits at the police academy “are limited in their life experiences and are barely in an adult stage of psychological development,” as they said in a recent paper in The Journal of the American Academy of Psychiatry and the Law.
The program has reduced injuries for both police officers and the mentally ill. Cochran said that families are now more willing to call police when they have a problem and that the mentally ill, who often become crime victims themselves, now see the police as their allies.
“The exciting thing is that this is a program that doesn’t hae to be seen as helpful only to citizens or helpful to police,” Dupont said.
Dupont said that the CIT program offers some hope for the saddest group of the mentally ill, those who have no families or have exhausted their families’ patience and are living on the streets, sometimes self-medicating with drugs and alcohol. Now, instead of automatically ending up in jail and then back on the street, they are taken to the psychiatric emergency room, where they are more likely to get the services they need.
In the 1960s and 1970s, court decisions and new laws gave the mentally ill more right to refuse treatment and set higher standards for psychiatric commitment. Recently, there have been calls to reverse the trend.
Dupont believes that is a “misleading issue,” that the real problem is that the services the mentally ill need are inadequate and that most know at some level that they need help and are trying to get it.
He said that CIT officers must learn to reach “the part of the person that wants help.”