Mental Illness Stigma: Limitations of Crisis Intervention Team Training

• Author: Cassidy Blair Haigh,Jonathan Allen Kringen,Anne Li Kringen
• Published date: 01 February 2020
• Date: 01 February 2020
• DOI: http://doi.org/10.1177/0887403418804871
• Subject Matter: Articles

https://doi.org/10.1177/0887403418804871

Criminal Justice Policy Review

2020, Vol. 31(1) 42 –57

© The Author(s) 2018

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DOI: 10.1177/0887403418804871

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Article

Mental Illness Stigma:

Limitations of Crisis

Intervention Team Training

Cassidy Blair Haigh1, Anne Li Kringen2,

and Jonathan Allen Kringen2

Abstract

As police departments in the United States strive to improve their capacity to

effectively engage individuals with mental illness (IMI), Crisis Intervention Team

(CIT) training has become increasingly common. Limited empirical work has studied

the effectiveness of CIT, and available studies demonstrate split evidence on the

effectiveness of the approach. Variation in previous findings may indicate that CIT

inadequately addresses key factors that create challenges for officers when engaging

IMI, such as mental illness stigma. Survey data collected from 185 officers were analyzed

to assess whether mental illness stigma affects officers’ perceptions of preparedness

for engaging IMI beyond CIT training itself. Findings suggest that although there are

few differences in perceptions of preparedness between officers who have completed

CIT training and those who have not completed CIT training, variation in levels of

mental illness stigma explain differences in officers’ perceptions of preparedness to

engage IMI. Policy recommendations are discussed.

Keywords

police, mental illness, stigma, Crisis Intervention Team, CIT

In recent years, public attention toward the relationship between individuals with men-

tal illness (IMI) and the American criminal justice system has intensified. It has

become increasingly apparent that the way mental health calls are often handled by

law enforcement is not the way these calls should be handled. For example, of the

1University of Florida, Gainesville, FL, USA

2University of New Haven, West Haven, CT, USA

Corresponding Author:

Cassidy Blair Haigh, University of Florida, Turlington Hall, 330 Newell Drive, Gainesville, FL 32603, USA.

Email: cassidyhaigh@ufl.edu

804871CJPXXX10.1177/0887403418804871Criminal Justice Policy ReviewHaigh et al.

research-article2018

Haigh et al. 43

nearly 2,000 fatal police shootings in 2015 and 2016, mental illness played a role in

one in four cases (The Washington Post, n.d.-a, n.d.-b). To improve the interaction

between law enforcement and IMI, various specialized response programs have been

created and implemented. Among these, the Crisis Intervention Team (CIT) model has

seen precipitous growth in adoption by police organizations. However, despite the

growth, few evaluations have demonstrated the effectiveness of CIT training.

Moreover, the limited studies available have rendered conflicting evidence concerning

CIT training’s ability to prepare officers to successfully engage IMI.

Given contradictory findings on CIT training in policing, other factors likely influ-

ence officers’ sense of preparedness for IMI interactions. Mental illness stigma, the

tendency to apply negative attributes to IMI, remains a significant barrier for positive

outcomes for IMI across a variety of domains (Guimon, Fischer, & Sartorius, 1999;

Hinshaw & Cicchetti, 2000; Stier & Hinshaw, 2007; Wahl, 1999), and although CIT

focuses on tools and skills to render better outcomes in IMI interactions, CIT training

may not effectively mitigate mental illness stigma in officers. Thus, officers’ percep-

tions and beliefs related to mental illness stigma may persist after CIT training account-

ing for differences in their sense of preparedness regarding engaging IMI.

Review of the Literature

On October 31, 1963, President John F. Kennedy signed the Community Mental

Health Centers Act. Originally intended to move IMI from long-term psychiatric hos-

pitals to mental health treatment centers in the community and to increase public

acceptance of IMI, some argue that the policy’s goals have not been met (Sheth, 2009).

Existing community mental health services are inadequately prepared to handle the

vast number of individuals requiring mental health treatment. As a result, this special

population has become the de facto responsibility of law enforcement who often serve

as first responders when IMI are experiencing psychiatric crises. All too often, IMI

end up in the criminal justice system where it is virtually impossible for them to get

the necessary treatment. In fact, housing IMI in jails and prisons is much more com-

mon today than treating them in hospitals (Fields & Phillips, 2013; Torey, Kennard,

Eslinger, Lamb, & Palve, 2010).

Evidence demonstrates that IMI are disproportionately in contact with officers

and constitute a substantial portion of officers’ time. It is estimated that 7% to 10%

of police activity involves responding to mental health calls, and police encounters

with IMI are typically longer in duration than calls with the non–mentally ill popula-

tion (Deane, Steadman, Borum, Veysey, & Morrissey, 1999). The combined impact

of these encounters results in other deleterious effects with IMI having 3 to 5 times

more contact with law enforcement than other non–mentally ill individuals, and an

arrest rate that is substantially higher (60% vs. 37%; Hartford, Heslop, Stitt, & Hoch,

2005; Heslop, Stitt, & Hoch, 2013). A review of literature regarding interactions

between IMI and police revealed that, overall, 40% of IMI have been arrested at

least once in their lifetime (Brink et al., 2011), and 76% of IMI in contact with police

have a history of previous charges (Schulenberg, 2016). Despite the number of