Megan Davidson, PhDAssistant Professor

Department of Criminal Justice East Carolina University

A CRIMINAL JUSTICE RESPONSE TO MENTAL

ILLNESS: AN EVALUATION OF THE

MEMPHIS CRISIS INTERVENTION TEAM

(CIT) TRAINING PROGRAM

INTRODUCTION

Mental illness is prevalent among individuals coming into contact with the criminal justice system: An estimated 7-10% of all police contacts involve a

person with a mental illness (Borum, Deanne, Steadman, & Morissey, 1998)

Over 50% of all State prisoners local jail inmates report having a mental health issue (James & Glaze, 2006)

Many problem-solving programs have been developed to address this issue: Focus on utilizing the criminal justice system as a

pathway to treatment Jail diversion to redirect flow of persons with a mental

illness away from incarceration toward appropriate treatment setting

Emerged in the late 1980s in response to a fatal police shooting of a person with a history of mental illness.

Developed by task force comprised of law enforcement, mental health providers, advocates, and academics.

Began as a jail diversion program to improve law enforcement response to mental health crises.

Has diffused to corrections, now system-wide model.

Two main components: 1) 40 hour training curriculum for first responders2) Community-wide collaboration between mental health & criminal justice agencies.

BACKGROUND OF MEMPHIS CRISIS INTERVENTION TEAM

(CIT) MODEL

Presentations from local mental health providers, advocates, consumers, and legal experts covering:Signs & symptoms of common mental illnessesPharmacology and related side effectsSuicide prevention PTSD among veteransTour of local mental health facilities Overview of de-escalation techniquesSubstance abuseDevelopmental disabilities

Role playing of verbal de-escalation

KEY ELEMENTS OF CIT TRAINING

PRIOR CIT LAW ENFORCEMENT STUDIES

• Surveys or focus groups• Assess effectiveness of

training

Officer-level studies

• Officer or agency reports• Examines diversionary

element

Disposition of CIT calls

• Utilize referral records• Compares CIT referrals to

other MH referrals – nature & outcome

Characteristics and

outcomes of CIT

referrals

CIT training effectively: Improves knowledge and perceptions of mental illness, mental health referral process & available community resources.

Enhances self-efficacy when responding to mental health crises.

Reduces use of force and injury to officers and others.

SUMMARY OF OFFICER-LEVEL STUDIES

Mixed results concerning CIT and diversion:Some studies have found that the implementation of CIT reduces arrest rates.

Studies have also found that mental health referral rates increase when agencies adopt CIT.

Other studies have revealed a minimal effect of CIT implementation on arrest & MH referrals.

SUMMARY OF CIT DISPOSITION STUDIES

Characteristics of CIT referrals do not differ significantly from other referral sources meaning: CIT-trained offi cers correctly identify individuals

in need of emergency psychiatric treatmentCIT referred patients more likely than the mental

health inquest warrant patients and less likely than routine referrals to receive outpatient follow-up referral.

CIT referred patients less likely than MH inquest and routine referrals to be hospitalized after evaluation.

More likely than other types of referrals to already have some involvement in MH system:Suggests chronic nature of CIT MH referrals vs.

short-term crisis

SUMMARY OF CIT REFERRAL CHARACTERISTICS AND

OUTCOMES

Only two studies conducted to-date examined implementation of CIT in several Maine jails.

Assessed effects of CIT training on offi cer response to inmates with mental illness.

Examined impact of CIT implementation on use of force incidents in the facility.

Found similar results to law enforcement studies: Improves officer self-efficacy when responding to inmates with mental illness

Increased use of verbal de-escalation and decreased use of force

CIT IN CORRECTIONS

Small sample sizesCover narrow geographical areasLack of follow-up period after CIT

trainingLimited assessment of CIT in

correctionsNo comparison of law enforcement &

correctional offi cers

LIMITATIONS OF PREVIOUS STUDIES

Dual-pronged approach to examining the Crisis Intervention Team (CIT) Model:

SCOPE OF DISSERTATION PROJECT

• Training EvaluationProng #1

• Exploring Impact of CIT implementation on CJ Agencies

Prong #2

Key Objective: Assess CIT training effectiveness

Sample: Law enforcement and correctional offi cers that completed

CIT training between June and December of 2012 in nine Florida counties.

Total Sample Size= 279 total offi cers (LEOs=179, COs=100)Research Design:

Panel study with three data collection points: 1) Pre-test (First day of CIT training) 2) Post-test (Last day of CIT training) 3) Follow-up (One month upon completion of CIT training)

Methodology: Pre and post-test: Paper questionnaires distributed in-

person Follow-up: Online questionnaire delivered via email

CURRENT STUDY: PRONG 1- TRAINING

EVALUATION

1) Knowledge of Mental Illness8 True/False Questions derived from CIT curricula

2) Perceptions of Self-Effi cacy6 Likert-scale questions (Strongly Disagree-Strongly Agree) measuring perceptions of ability to mange incidents involving persons with a mental illness

3) Perceptions of Verbal De-Escalation 3 Likert-scale questions (Strongly Disagree-Strongly Agree) measuring perceptions of verbal de-escalation techniques

KEY MEASURES

DEMOGRAPHICS (N=279)

Variable N % Variable N % Variable #Officer Type     Volunteer Status     Age  

Law Enforcement 179 64 Volunteer 172 62 Minimum 20

Correctional 100 36 Non-Volunteer 103 37 Maximum 60

White     Missing 4 1 Mean 36

White 208 75 Prior MH Training     SD 9

Non-White 71 25 Yes 150 54    

Hispanic     No 123 44 Years of Service  

Hispanic 45 16 Missing 6 2 Minimum 0

Non-Hispanic 232 83 Know Someone with MI     Maximum 32

Missing 2 1 Yes 89 32 Mean 8

Sex     No or “Don’t Know” 187 67 SD 7

Male 220 79 Missing 3 1    

Female 59 21    

Rank        

Line Officer 218 78    

Supervisor 59 21    

Missing 2 1    

Paired-samples t-tests were conducted to examine mean changes between the pretest and posttest

IMMEDIATE TRAINING EFFECTS (N=279)

Measures PretestMean

Posttest SD t df

H1: Knowledge of Mental Illness

5.85 (out of 8) 6.67 1.375 9.836*** 271

H2: Self Efficacy 15.71 (out of 24) 19.62 4.55 14.09*** 268

H3: Perceptions of VerbalDe-escalation

9.89 (out of 12) 10.65 2.52 4.980*** 271

Note: *** = p < .001

Significant increase across all three measures between pretest and posttest. Perceptions of self-efficacy increased by approximately 16%.

Knowledge of Mental Illness increased by 10%Perceptions of Verbal De-escalation improved by 6%.

Any growth on these measures is considered an indication of training effectiveness.

IMMEDIATE TRAINING EFFECTS

Paired-samples t-tests were conducted to examine mean changes between the posttest and follow-up for 3 measures

INTERMEDIATE TRAINING EFFECTS (N=117)

Variable PosttestMean

Follow-UpMean

SD t df

H1: Knowledge of Mental Illness

6.69 (out of 8) 6.67 .95 .22 95

H2: Self-Efficacy 20.12 (out of 24) 14.61 3.90 14.07*** 98

H3: Perceptions of Verbal De-escalation

11.03 (out of 12) 7.73 2.61 12.64*** 99

Note: *** = p < .001

No real change on Knowledge of Mental Illness measure

22% decline on Self-Effi cacy measure28% decrease on Perceptions of Verbal

De-escalationThese declines represent a diminishing effect, or decay, of the training over time.

INTERMEDIATE TRAINING EFFECTS

Effect β SEModel 1: Knowledge of Mental Illness    

Time 1 (Pretest) -.694** .128Time 2 (Posttest) .031 .122

Sex (Female) -.078 .127Prior Mental Health Training -.064 .120

Volunteer Status .074 .126Model 2: Self-Efficacy    

Time 1 (Pretest) 1.27** .451Time 2 (Posttest) 5.39** .390

Sex (Female) -1.25 .536Model 3: Perceptions of Verbal De-escalation    

Time 1 (Pretest) 2.545** .244Time 2 (Posttest) 3.227** .228

Race (Non-White) .234 .282Rank (Patrol) -.074 .250

MEASURING CHANGE OVER TIME:

GROWTH CURVE MODELS (N=117)

Note: **= p <.01Note: Reference categories for variables: Time 3 (Follow-Up), Sex (Male), Prior mental health (Yes), Volunteer status (Volunteer), Race (White), Rank (Supervisor)

Time 1 (pretest) and Time 2 (posttest) were compared to Time 3 (follow-up)

Time was a significant predictor of growth in all three models

Knowledge of Mental Illness Offi cers’ scores at Time 1 were significantly lower (9%) than

Time 3. Offi cers’ scores at Time 2 were slightly greater (<1%) than

Time 3.Self-Effi cacy

Offi cers’ scores at Time 1 and Time 2 were significantly higher than Time 3, (5% and 22% respectively).

Perceptions of Verbal De-Escalation Offi cers’ scores at Time 1 and Time 2 were significantly

higher than Time 3, (21% and 28% respectively).

GROWTH CURVE MODELS (N=117)

A series of independent samples t-tests were conducted & change variables were created

Tested the relationships between the variables below and the immediate and intermediate training effects:

OFFICER CHARACTERISTICS & TRAINING EFFECTIVENESS

• Sex • Race• Ethnicity • Rank• Age• Years of Service

• Volunteer Status• Prior Mental Health

Training • Know Someone with

Mental Illness

Immediate Training Eff ects:Knowledge of Mental Illness:

Officers without prior mental health training gained significantly more than officers with prior mental health training.

Non-volunteers gained significantly more than officers that volunteered for the training.

Self-Effi cacy:Females gained significantly more than males.

Verbal De-Escalation:No significant differences noted.

FINDINGS: OFFICER CHARACTERISTICS & TRAINING

EFFECTIVENESS

Intermediate Training Eff ects: Self-Effi cacy:

Unranked officers lost more than ranked officers.

Non-white officers experienced a greater deterioration than white officers.

Verbal De-Escalation: No significant differences noted.

Knowledge of Mental Illness:No significant differences noted.

FINDINGS: OFFICER CHARACTERISTICS & TRAINING

EFFECTIVENESS

On follow-up survey: Offi cers were asked how their knowledge & perceptions of MH services & referral process changed as a result of CIT training

ADDITIONAL TRAINING FINDINGS

  Correctional Officers Law Enforcement OfficersMeasure N % N %

Perceptions of MH Services        Worsened 1 3 0 0

Stayed the Same 15 40 16 25Improved 21 57 47 75

Knowledge of MH Referral        Worsened 0 0 0 0

Stayed the Same 18 49 15 23Improved 19 51 48 76

Knowledge of MH Services        Worsened 0 0 0 0

Stayed the Same 14 38 9 14Improved 23 62 54 86

Over 85% of offi cers indicated these elements have been somewhat or very useful in their encounters since the training: How to recognize signs and symptoms of various mental

illnesses How to distinguish between developmental disorders and

mental illnesses How to identify and respond to a person engaging in self-

harming or suicidal behavior How to access available community mental health resources Understanding the mental health referral process in your

community How to verbally de-escalate a person experiencing a

mental health crisis How to physically approach an individual

experiencing a mental health crisis

MOST IMPORTANT ASPECTS OF CIT TRAINING

Nature of Incidents Involving Law Enforcement offi cers: Most likely to encounter individual with mental illness

when individual was subject of call for assistance. NOT as a suspected offender

Nearly 2x as likely to take no action or initiate a MH referral than to arrest when encountering a person with a mental illness.

Nature of Incidents Involving Correctional Offi cers: Most likely to encounter inmate with mental illness when

inmate was perpetrator of an attack/exploitation of another inmate and/or the subject of a rule violation.

More likely to take no action or initiate a MH referral than to initiate the disciplinary process when encountering inmates with a mental illness.

OTHER KEY OFFICER FINDINGS

Sample: Representatives of law enforcement and correctional

agencies that participate in the CIT program in the nine Florida counties in which offi cers were trained

Total Sample Size= 24 representatives of CJ agencies 6 correctional, 18 law enforcement

Research Design: Cross-sectional survey distributed at one point in time

(November 2012) Methodology:

Online questionnaire delivered via emailAnalytical Strategy:

Content Analysis

CURRENT STUDY: PRONG 2- IMPACT OF CIT ON CJ

AGENCIES

All representatives indicated their agency has a positive relationship with local mental health providers and/or advocacy organizations.

Impact on Operations & Outcomes: 13/18 (72%) indicated CIT decreased incidence of offi cer

injury 15/18 (83%) indicated CIT decreased incidence of injury to

persons with a mental illness 15/18 (83%) indicated CIT decreased use of force in

situations involving persons with a mental illness 13/18 (72%) indicated CIT decreased use of SWAT or

Hostage Negotiation Teams

*** Remaining respondents indicated these factors stayed the same after CIT implementation

IMPACT OF CIT IMPLEMENTATION ON LAW ENFORCEMENT AGENCIES

All representatives indicated their agency has a positive relationship with local mental health providers and/or advocacy organizations.

Impact on Operations & Outcomes: 6/6 (100%) indicated CIT decreased incidence of offi cer injury 5/6 (83%) indicated CIT decreased incidence of inmate injury

The remaining representative did not answer this question. 5/6 (83%) indicated CIT decreased use of force in situations

involving inmates with a mental illness The remaining representative did not answer this question.

4/6 (67%) indicated CIT decreased use of cell extraction teams One person did not answer and one person indicated no change.

4/6 (67%) indicated CIT decreased use of segregation or isolation One person did not answer and one person indicated no change.

IMPACT OF CIT IMPLEMENTATION ON CORRECTIONAL AGENCIES

The training achieves the intended offi cer-level objectives measured in this study.

The training is eff ective for both law enforcement and correctional offi cers.

Offi cers experience a signifi cant decline on self-effi cacy and perceptions of verbal de-escalation measures between posttest and follow-up. May indicate CIT gives false sense of security and incidents

may not be resolved as easily as expected when returning to duty.

Offi cer sex, race, rank, prior mental health training, and volunteer status are related to susceptibility to training.

Law enforcement and correctional offi cers are more likely to initiate a MH referral or take no action rather than arrest or initiate a disciplinary infraction in CIT-related incidents.

CIT TRAINING CONCLUSIONS

CIT improves communication between law enforcement/correctional agencies and mental health providers/advocates.

CIT implementation has positive impact on CJ agencies by decreasing:Use of force Incidence of officer/suspect/inmate injuryUse of specialty units (SWAT, cell extraction)

Use of segregation

CIT IMPACT ON AGENCIES CONCLUSIONS

THANK YOU FOR ATTENDING

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