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Patrol Paradigm Shift: CIT and the Mentally Ill

A Crisis Intervention Team (CIT) program is a cooperative between law enforcement, mental health professionals and those affected by mental illness.

The primary purpose is to safely and peacefully de-escalate mental health-related crisis situations. Coordinating training and resources between law enforcement and the mental health community prior to an incident can result in better outcomes for everyone.

CIT training provides an opportunity for officers to learn more about what mental illness is and how it can affect the entire community. More importantly, CIT training introduces the idea that it is sometimes acceptable for law enforcement to respond, refer the person to others and walk away. Instructors provide an overview of different mental illnesses, how to recognize the various characteristics and techniques for confronting someone having a crisis.

Family members discuss the challenges of living with a mentally ill person and what they hope will happen when they call 911. Mental health professionals review common misconceptions and provide education what services are available in the community. Some programs also invite people with mental illnesses to provide a firsthand view of what it is like for them to interact with police.

Talk Instead of Transport

Before CIT programs the idea of just talking with someone in a mental illness crisis was not always an option. “You went in, you took control of the person and you took them where they needed to go,” says Sergeant Kathy McNicholas, CIT Coordinator for the Vancouver, Wash., Police Department. But this idea of automatic transport was not always necessary for the person or a productive use of the officer’s time.

Many times the reason behind the crisis is a simple lack of knowledge of where to turn for help and can be addressed without the need for jail or hospitalization. If the responding officer can use the skills learned in CIT training to calm the person and provide information on available resources a custody may not be required.

CIT training also shows the law enforcement community is responding to a changing culture that has lessened the stigma of mental illness. “It is more prevalent in society today. The families are not hiding their little nephew in the back room for a lifetime,” McNicholas said. “They are in the mainstream, functioning, and they can have an episode at any time.” This means that officers may have more interaction with those with a mental illness who are not necessarily dangerous, but are in crisis and have nowhere else to turn. This is when CIT training becomes crucial.

Less Force Is Expected

As society becomes more accepting of those with mental illness, it becomes less tolerant of situations that end with a use of force. As a result, departments are expected to attempt to make contact with the person first and at least try to solve the situation at the lowest level according to McNicholas. However, even when justified, questions will arise. “Could we have negotiated him into an ambulance or into the back of a police car without use of force?” McNicholas asked.

According to McNicholas the need for the use of force went substantially down after the CIT program started at VPD because officers began to use the skills they learned to either refer and walk away or talk the person into voluntarily getting into the patrol car or ambulance. “There was no need to use force every time we dealt the mentally ill” she says. This decreased complaints and increased better relationships between the police department and the mental health community.

These improved relationships are an advantage for everyone involved in dealing with the mentally ill. Officers have improved skills for how to defuse a crisis, the family has a better understanding of the officer’s actions and those with mental illness feel more confident calling for help because they know what to expect. This ability to work together can help everyone be safer during a mental health crisis.

Biggest Paradigm Shift

The drop in use of force complaints can benefit administration and the mental health community. But does an ability to figure out what kind of mental illness someone has change the outcome for the officer? McNicholas says yes. Of course, a CIT certificate does not mean checking the street survival brain at the door. Officer safety always comes first and even the best trained CIT officer may not have the luxury of talk therapy while an armed suspect rushes him.

Rather, CIT training kicks in when there is time to defuse a situation safely. According to McNicholas, this can be the biggest paradigm shift for officers. Rather than swooping in and taking the person into custody, CIT requires gathering intel to work with the person to find a solution other than an arrest.

Requiring CIT training should not imply that officers who have not been officially trained are incapable of dealing with the mentally ill. “Most officers are negotiators every day,” McNicholas says. CIT adds that extra bit of education to help officers determine if the person is showing signs of mania, depression or schizophrenia and what the different approaches are for each illness. It is that education of initially reading that person to get them the help they need and where they need to go.

Change the Outcome

Why is this important? Because learning how to approach a person having a mental health crisis properly can change the result of the encounter. Someone suffering from depression, for example, is still able to focus on verbal instructions. But a person with schizophrenia, suffering from auditory hallucinations, may not be able to separate the instructions coming from the officer from the other voices he is hearing. Knowing the correct techniques to address different challenges can lead to successfully talking him down without taking him down.

Many times resolving the situation will end with using calming skills to start a conversation and then to simply refer and walk away. “When I started 16 years ago it was, ‘Oh, you’re going to the jail or the hospital. You choose.’ and then you used force and they went,” McNicholas said.

Today, a CIT officer can work with the person to determine if there is a need to take him out of his home. Sometimes it is as easy as helping the person to calm down and contact a counselor or mental health team or provide resources of names of organizations he can contact. For the officer, this can relieve the frustration of hauling a non-violent person off to jail again and again by providing a better answer to the situation.

With all the recent budget cuts, this role of officers as counselors is not going to end anytime soon. “There are more of them out there, more not getting their medications due to budget cuts, and it is easier to self-mediate with alcohol or drugs than wait for the 5th of the month to get to Walgreens to get their prescription,” McNicholas says.

Using CIT skills to address the issue at the initial contact may take longer, but may make everyone’s lives easier. “We are giving them the resources and education they need to manage their families so dispatch doesn’t ever get called again,” she says. Understanding the options for a better outcome benefits everyone, officers included.

Stop Hitting the Cat

“This is 9-1-1, how can I help you?” “My 10 year old son is schizophrenic and won’t listen to a thing I say, so I need an officer to come to my house and make him behave.”

“This is 9-1-1, what is your emergency?” “My bi-polar eight-year-old daughter won’t stop hitting the cat. I need an officer to come deal with her.”

With budget cuts and the loss of safety nets these 911 scenarios are becoming more common and there is seemingly no end in sight. A National Institute of Mental Health (NIMH) survey found that 20% of teens in the United States are affected by a mental illness. Unprepared to cope with their out of control offspring, parents are increasingly calling upon law enforcement to help them parent.

So what is an officer supposed to do when faced with a mom who insists that an officer make her bipolar eight year old stop hitting the cat? Or for the dad who cannot keep his ten year old with ADHD from running away? Or for the 12-year-old who calls 911 and says he is on antidepressants and suicidal?

Standard Welfare Check

According to Ellis Amdur, a CIT Trainer who specializes in face-to-face encounters with agitated and mentally ill people, responding to a call of a mentally ill child begins just like any other welfare check. It is all about observation. Is there an immediate risk to anyone due to the situation at hand? Is the child in a safe environment? Is he clothed, fed, clean?

Once those questions are answered, a call about a mentally ill child may be more about the parents than the child. “Are this child’s needs being adequately met by the response the child’s parents are giving?” Amdur asked. Has mom done all she can to protect her child and is simply at her wits end? Or has she given up and is letting him wander the streets at night because she cannot cope? Has dad been taking his bipolar daughter to her counseling sessions? Or does he lock her in the closet when she will not behave because “she is crazy”?

When dealing with calls about parenting mentally ill children, Amdur says officers are simply the first step in a longer process. “All the officer is supposed to be doing is making a behavioral observation, then responding to that behavior,” Amdur said. For the stable parent who simply needs guidance on how to cope, a referral to a local agency may suffice.

However, if the parents are not doing due diligence to ensure their child is safe a protective hold may be necessary, according to Amdur. Not because the child is mentally ill, but because the environment the parents are providing is not meeting the child’s needs. Then it becomes critical to use those observational skills and involve the agencies with the training and resources to respond, like Child Protective Services, the CIT unit, local mental health agencies or a nearby hospital.

Even if the child is in a safe environment, it is vital that the officer documents what he found. “That record of an unbiased observer, outside of the parents, can in some cases really help the child,” Amdur said. In addition, if a situation with a child ends badly in the future, a report shows the officer responded, observed and forwarded information to the correct agencies if needed. This can protect both officer and agency from claims that not enough was done to protect the child.

Dealing with mental illness in children can be challenging for everyone involved. Many CIT programs offer education dealing specifically with children and include crisis assessment and intervention, education on childhood mental illnesses, even resources for stressed out parents. More importantly, this training can help officers overcome the feeling they are only there to teach a parent how to parent.

Kelly Sharp is a partner in Workplace Consulting NW, LLC, which provides a variety of training and management classes. She can be reached at

Published in Law and Order, Jan 2012

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