Mental Health Crisis Location and Police Transportation Decisions: The Impact of Crisis Intervention Team Training on Crisis Center Utilization
| Author | Leonard Swanson,Sheryl Kubiak,Erin B. Comartin |
| DOI | 10.1177/1043986219836595 |
| Published date | 01 May 2019 |
| Date | 01 May 2019 |
| Subject Matter | Articles |
research-article2019
Article
Journal of Contemporary Criminal Justice
2019, Vol. 35(2) 241 –260
Mental Health Crisis Location
© The Author(s) 2019
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https://doi.org/10.1177/1043986219836595
DOI: 10.1177/1043986219836595
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Decisions: The Impact of
Crisis Intervention Team
Training on Crisis Center
Utilization
Erin B. Comartin1, Leonard Swanson1,
and Sheryl Kubiak1
Abstract
Crisis Intervention Team (CIT) research has shown increases in officer transports of
individuals with serious mental illness to emergency departments (ED) which, while
more appropriate than incarceration, can be expensive and lack linkage to long-term
mental health services. Mental health crisis centers offer a promising alternative, but
impact may be limited by proximal distance and lack of officer awareness. To address
this concern, this study asked, “Does CIT training affect officer transport decisions
to a crisis center over a nearby ED?” Researchers analyzed crisis call reports in a
Midwestern county and found increased use of the crisis center and decreased use
of EDs by officers after CIT was implemented. The crisis location affected officer
transport decisions, yet CIT officers were more likely than non-CIT officers to travel
farther for appropriate linkage. Findings suggest CIT changes officer behavior, which
could potentially lead to long-term, low-cost treatment for individuals with serious
mental illnesses when there is a mental health crisis center.
Keywords
crisis location, Crisis Intervention Team, officer training, officer decisions, mental
health, crisis center
1Wayne State University, Detroit, MI, USA
Corresponding Author:
Erin B. Comartin, Assistant Professor of Social Work, Center for Behavioral Health and Justice, School
of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA.
Email: at9766@wayne.edu
242
Journal of Contemporary Criminal Justice 35(2)
Introduction
Police are often the first responders to mental health or suicidal incidents (Bittner,
1967), yet linkage to treatment services is often either uncommon or unverified
(Reuland, Draper, & Norton, 2010). Several communities have adopted the Crisis
Intervention Team (CIT) model to bridge partnerships between law enforcement,
mental health agencies, advocates, and families, to train officers and develop an
appropriate systemic response (Dupont, Cochran, & Pillsbury, 2007). Some CIT pro-
grams have established mental health crisis centers as a low-cost, no-refusal, quick-
turnaround treatment alternative to hospitalization (Steadman et al., 2001), and yet,
police officers may not know of or utilize this resource, particularly if the mental
health or suicidal incident was far away. This exploratory study asked, “Does CIT
training affect officer transport decisions to a crisis center over a nearby emergency
department (ED)?” Using officer call reports, researchers used interrupted time series
(ITS) analyses and logistic regression models to assess the behavioral outcomes of
CIT training and the impact of distance between crisis locations and treatment ser-
vices. The location of this study was a Midwestern county that implemented three
primary components of the CIT model.
Background
People with mental illness are overrepresented in the criminal/legal system. In U.S.
jails, 44% of inmates have been told by a mental health professional that they had a
psychological disorder and 26% met the criteria for a serious psychological disorder
(Bronson & Berzofsky, 2017). Moreover, incarcerating individuals with a serious
mental illness (SMI) has shown to exacerbate their symptoms and deteriorate quality
of life (Mallik-Kane & Visher, 2008). Thus, the criminal/legal system’s intersection
with mental illness deserves thorough inspection, particularly if interventions early
on (i.e., law enforcement) could prevent people with mental illness from experienc-
ing deeper punitive entrenchment (Munetz & Griffin, 2006).
Early research on police interactions with individuals with SMI suggested that
this population posed a greater risk of arrest (Bittner, 1967; Teplin, 1984). Engel
and Silver (2001) found conflicting arrest rates among different departments,
time periods, and methods of analysis, arguing police behavior was not a primary
driver behind mental illness prevalence rates in jails and prisons. Nevertheless,
there tends to be broader agreement that traditional police responses, namely,
informal resolutions, arrest, or hospitalization, do not produce encouraging out-
comes for police or afflicted persons (Reuland et al., 2010). At worst, people with
SMI are 16 times more likely to be killed in a police incident (Fuller, Lamb,
Biasotti, & Snook, 2015). Even when transporting individuals to hospital, Reuland
and Yasuhara (2015) note that officers spend considerable resources on this popu-
lation, “. . . only to find them released back into the community before the offi-
cers have returned to patrol” (p. 41).
Comartin et al.
243
CIT Model
To address harmful and ineffective police responses to mental health crises, the CIT
model encourages collaboration between police, mental health treatment providers,
consumers, and families to customize local, systemic solutions to the criminalization
of individuals with SMI (Dupont et al., 2007; Teller, Munetz, Gil, & Ritter, 2006).
Among 10 core elements, complete implementation includes 40 hr of police training,
the establishment of an emergency mental health receiving facility with minimal turn-
around time, and community collaboration.
Nascent CIT research has focused on CIT’s 40-hr police training and shown
varying results, depending on the outcome. Evidence remains mixed on whether
CIT training affects arrest rates; some studies show CIT officers arrest subjects at
significantly lower rates than their non-CIT counterparts (Compton et al., 2014b;
Steadman, Deane, Borum, & Morrissey, 2000), whereas other studies show no
significant impact on arrest decisions (Taheri, 2016; Teller et al., 2006; Watson
et al., 2010). CIT training has been linked with increases in officers’ recognition
of psychiatric emergencies (Compton, Bahora, Watson, & Oliva, 2008; Strauss
et al., 2005), resulting in an increased amount of calls identified as mental distur-
bances by dispatchers (Teller et al., 2006). In addition, CIT training increased
officers’ self-efficacy about successfully de-escalating an individual in crisis
(Compton et al., 2014a; Kubiak et al., 2017) and increased transports to treatment
services (Steadman et al., 2000; Teller et al., 2006). However, little is known about
the type of service provider where officers transport individuals with SMI (Brink
et al., 2012).
Linkage to Mental Health Treatment
When the CIT model was first established, law enforcement collaborated with local
EDs to establish a drop-off location for individuals in crisis. Wood, Watson, and
Fulambarker (2017) note that this initial collaboration with EDs resulted in costly,
repetitive cycles of hospital recidivism. Follow-up, noncrisis services could help
stabilize mental health symptoms and possibly decrease the chances of re-engage-
ment with law enforcement. The CIT model encourages officers to refer individuals
with SMI to community partners for mental health treatment, such as a 24-hr crisis
center (Compton et al., 2008; Compton et al., 2014b; Dupont et al., 2007; Steadman
et al., 2001; Wood & Beierschmitt, 2014), where mental health professionals can
guide the individual to a network of follow-up service providers (Wood et al.,
2017). A crisis center, in conjunction with CIT officer training, provides a source of
immediate entry into the local mental health system (Dupont et al., 2007). Ideally,
this center streamlines intake to minimize officer wait-time and expedites the police
drop-off (Steadman et al., 2001) with a no-refusal policy to evaluate involuntary
mental health treatment criteria. Long wait-times often frustrate and dissuade offi-
cers from referring to mental health services (Steadman et al., 2001; Wood &
Beierschmitt, 2014). A crisis center might not mandate treatment solutions for
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Journal of Contemporary Criminal Justice 35(2)
clients upon arrival, but a no-refusal policy would provide a safe, reliable transport
option as opposed to an ED or county jail.
The location of a mental health or suicidal incident, and its proximity to local
resources, affects community response. Rural areas tend to host fewer mental health
professionals, whereas denser urban communities tend to have more capacity and a
highly skilled workforce (Ellis, Konrad, Thomas, & Morrissey, 2009). Fewer mental
health facilities in a given area likely increase the travel time and distance to access
appropriate care. Even if a crisis center offered a no-refusal policy and minimized
wait-time, its impact may be limited for rural officers who prefer a shorter drive to the
nearby hospital. Moreover, officers stationed in distant areas may not know that their
county crisis center exists. Although it may not be practically or fiscally possible to
establish mental health crisis centers in sparsely populated areas, the marginal impact
of CIT training on rural officer transport decisions could increase the chances of an
appropriate referral.
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