Utilizing Crisis Intervention Teams in Prison to Improve Officer Knowledge, Stigmatizing Attitudes, and Perception of Response Options

• Author: Scott O’kelley,Kelli E. Canada,Amy C. Watson
• DOI: 10.1177/0093854820942274
• Published date: 01 January 2021
• Date: 01 January 2021
• Subject Matter: Articles

CRIMINAL JUSTICE AND BEHAVIOR, 2021, Vol. 48, No. 1, January 2021, 10 –31.

DOI: https://doi.org/10.1177/0093854820942274

Article reuse guidelines: sagepub.com/journals-permissions

© 2020 International Association for Correctional and Forensic Psychology

10

UTILIZING CRISIS INTERVENTION TEAMS IN

PRISON TO IMPROVE OFFICER KNOWLEDGE,

STIGMATIZING ATTITUDES, AND PERCEPTION

OF RESPONSE OPTIONS

KELLI E. CANADA

University of Missouri

AMY C. WATSON

University of Illinois at Chicago

SCOTT O’KELLEY

Missouri Department of Corrections

People with mental illness (MI) are overrepresented in prisons, in part, because people with MI stay in prison longer.

Correctional officers (COs) use discretion in force, violations, and segregation. Crisis intervention teams (CITs) are being

used in corrections to reduce disparities in sanctioning and improve safety. This quasi-experimental, mixed-methods study

includes 235 CIT COs who were surveyed before and after training on knowledge of MI, stigmatizing attitudes, and percep-

tion of response options. Non-CIT (n = 599) officers completed the same survey. Randomly selected CIT COs completed

interviews 6 to 9 months following training (n = 17). CIT COs had significantly lower stigmatizing attitudes, more mental

health knowledge, and better perceptions of options following CIT training compared with non-CIT COs. This preliminary

work on CIT use in prison is promising; additional work is needed to determine whether these changes result in behavior

change among COs and improvements in outcomes for people with MI.

Keywords: crisis intervention teams; prison; correctional officers; serious mental illness

Approximately 1.3 million people in the United States are incarcerated in state prisons

(Sawyer & Wagner, 2019). Estimates of serious mental illness (MI) among the prison

population range from 2% to 10% for schizophrenia, 2% to 16% for bipolar disorders, and 4%

to 29% for major depressive disorder (Fazel et al., 2016; Prins, 2014). Across most studies, the

prevalence of serious MI is higher among people in prison compared with the community

(Bronson & Berzofsky, 2017; Fazel et al., 2016). For diagnoses such as posttraumatic stress

disorder, prevalence rates among incarcerated women far outweigh community prevalence

rates (up to 48% compared with 5%, respectively; National Institute of Mental Health, 2017;

Prins, 2014). The overrepresentation of people with MI in the criminal justice system prompted

AUTHORS’ NOTE: This project was funded by the Fahs Beck Fund for Research and Experimentation and

the Hammond Institute. Correspondence concerning this article should be addressed to Kelli E. Canada,

Integrative Behavioral Health Clinic, School of Social Work, University of Missouri, 706 Clark Hall, Columbia,

MO 65211; e-mail: canadake@missouri.edu.

942274CJBXXX10.1177/0093854820942274Criminal Justice and BehaviorCanada et al. / Short Title

research-article2020

Canada et al. / UTILIZING CIT IN PRISON 11

implementation of jail-diversion and court-based programming aimed at diverting people

with MI from incarceration and engaging them in community-based treatment rather than

serving time in prison. Despite expansion of these programs and a decline in the prison popu-

lation, the proportion of people with MI in prison remains higher than in community popula-

tions (Hirschtritt & Binder, 2017). Disparities in the number of people with MI in prison are

one of the foci for smart decarceration strategies (Epperson & Pettus-Davis, 2017). Additional

interventions at policy and program levels are needed to ethically and equitably reduce the

population of people in custody without worsening already existing disparities.

One contributor to the overrepresentation of people with MI in prison is that they are

spending, on average, 15 months longer in prison than people without MI, even when

charged with similar crimes (Ditton, 1999). While sentence lengths are not significantly

different for people with MI (Bronson & Berzofsky, 2017), they are more likely to serve

their entire sentence rather than qualifying for early release or parole (Fellner, 2006; Harris

& Dagadakis, 2004). This difference is, in part, due to people with MI being disproportion-

ately impacted by institutional policies and practices. People with MI in prison receive

higher rates of violations and rule infractions (Ditton, 1999; Matejkowski et al., 2010) and

are 4 times more likely to receive harsher sanctions for minor infractions (Houser &

Belenko, 2015).

PHYSICAL AND MENTAL HEALTH OUTCOMES FOR PEOPLE WITH MI IN PRISON

The symptoms of MI create challenges to following prison rules and complying with

officer commands (Fazel et al., 2016). Specific symptoms of mental disorders vary in

type and impact; across disorders, symptoms of MI impact perceptions, cognitions,

behaviors, interpersonal interactions, and emotional experiences and expression (see

the Diagnostic and Statistical Manual of Mental Disorders [5th ed.; DSM-V]; American

Psychiatric Association, 2013). For example, a person with schizophrenia may experi-

ence hallucinations and delusions while a person with major depressive disorder may

be unable to concentrate, feel fatigued, isolate, feel worthless, and have thoughts of

suicide. Having these symptoms can create barriers to following rules and routines

required in prison.

The prison environment poses numerous risks to physical and mental health. For the

general population, life expectancy declines 2 years for every year served in prison

(Patterson, 2013). Individual differences in the ability to adapt to prison, limited health

care programs within prison, social isolation, segregation, and stress resulting from risk

of violence and prison conditions can lead to adverse health and mental health outcomes

(Nurse et al., 2003; Schnittker & John, 2007), including high risk of communicable dis-

eases, poor treatment of chronic health conditions, and higher mortality (Macalino et al.,

2004; Patterson, 2013).

The prison environment is especially risky for people with MI and can be physically and

emotionally traumatic. Punitive responses to mental health events like self-injury (e.g., cut-

ting, suicide attempts) can worsen symptoms, retraumatize people, and prolong treatment

engagement (Lanes, 2011; Smith, 2014). People with MI in prison are at heightened risk of

physical and sexual victimization, suicide, and being sent to segregation (Baillargeon et al.,

2009; Blitz et al., 2008; Fazel et al., 2016; Fellner, 2006; Wolff et al., 2007). Segregation,

particularly for extended periods, can cause mental decompensation and worsen symptoms,