Transcript A Criminal Justice Response to Mental Illness: An

A CRIMINAL JUSTICE
RESPONSE TO MENTAL
ILLNESS: AN EVALUATION OF
THE MEMPHIS CRISIS
INTERVENTION TEAM (CIT)
TRAINING PROGRAM
Megan Davidson, PhD
Assistant Professor
Department of Criminal Justice
East Carolina University
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
BACKGROUND OF MEMPHIS CRISIS
INTERVENTION TEAM (CIT) MODEL
 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 responders
2) Community-wide collaboration between mental health & criminal
justice agencies.
KEY ELEMENTS OF CIT TRAINING
 Presentations from local mental health providers,
advocates, consumers, and legal experts covering:
 Signs & symptoms of common mental illnesses
 Pharmacology and related side effects
 Suicide prevention
 PTSD among veterans
 Tour of local mental health facilities
 Overview of de-escalation techniques
 Substance abuse
 Developmental disabilities
 Role playing of verbal de-escalation
PRIOR CIT LAW ENFORCEMENT STUDIES
Officer-level
studies
•Surveys or focus groups
•Assess effectiveness of training
Disposition of
CIT calls
•Officer or agency reports
•Examines diversionary element
Characteristics
and outcomes
of CIT referrals
•Utilize referral records
•Compares CIT referrals to other MH
referrals – nature & outcome
SUMMARY OF OFFICER-LEVEL STUDIES
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 CIT DISPOSITION 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 REFERRAL
CHARACTERISTICS AND OUTCOMES
 Characteristics of CIT referrals do not differ significantly
from other referral sources meaning:
 CIT-trained officers correctly identify individuals in need of
emergency psychiatric treatment
 CIT 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
CIT IN CORRECTIONS
 Only two studies conducted to-date examined
implementation of CIT in several Maine jails.
 Assessed effects of CIT training on officer
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
LIMITATIONS OF PREVIOUS STUDIES
Small sample sizes
Cover narrow geographical areas
Lack of follow-up period after CIT training
Limited assessment of CIT in corrections
No comparison of law enforcement &
correctional officers
SCOPE OF DISSERTATION PROJECT
Dual-pronged approach to examining the
Crisis Intervention Team (CIT) Model:
Prong #1
Prong #2
• Training
Evaluation
• Exploring Impact of
CIT implementation
on CJ Agencies
CURRENT STUDY:
PRONG 1- TRAINING EVALUATION
 Key Objective:
 Assess CIT training effectiveness
 Sample:
 Law enforcement and correctional officers that completed CIT
training between June and December of 2012 in nine Florida
counties.
 Total Sample Size= 279 total officers (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
KEY MEASURES
1) Knowledge of Mental Illness
 8 True/False Questions derived from CIT curricula
2) Perceptions of Self-Efficacy
 6 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 deescalation techniques
DEMOGRAPHICS (N=279)
Variable
Officer Type
Law Enforcement
Correctional
White
White
Non-White
Hispanic
Hispanic
Non-Hispanic
Missing
Sex
Male
Female
Rank
Line Officer
Supervisor
Missing
N
%
179
100
64
36
208
71
75
25
45
232
2
16
83
1
220
59
79
21
218
59
2
78
21
1
Variable
Volunteer Status
Volunteer
Non-Volunteer
Missing
Prior MH Training
Yes
No
Missing
Know Someone with MI
Yes
No or “Don’t Know”
Missing
N
%
Variable
#
Age
172
103
4
62
37
1
150
123
6
54
44
2
89
187
3
32
67
1
Minimum
Maximum
Mean
SD
20
60
36
9
Years of Service
Minimum
Maximum
Mean
SD
0
32
8
7
IMMEDIATE TRAINING EFFECTS (N=279)
 Paired-samples t-tests were conducted to examine mean
changes between the pretest and posttest
Measures
Pretest
Mean
Posttest
𝑴𝒆𝒂𝒏
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 Verbal
De-escalation
9.89 (out of 12)
10.65
2.52
4.980***
271
H1: Knowledge of Mental
Illness
Note: *** = p < .001
SD
t
df
IMMEDIATE TRAINING EFFECTS
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.
INTERMEDIATE TRAINING EFFECTS
(N=117)
 Paired-samples t-tests were conducted to examine mean
changes between the posttest and follow -up for 3 measures
Variable
H1: Knowledge of Mental
Illness
H2: Self-Efficacy
H3: Perceptions of Verbal
De-escalation
Note: *** = p < .001
Posttest
Mean
6.69 (out of 8)
Follow-Up
Mean
6.67
SD
t
df
.95
.22
95
20.12 (out of 24)
14.61
3.90 14.07***
98
11.03 (out of 12)
7.73
2.61 12.64***
99
INTERMEDIATE TRAINING EFFECTS
No real change on Knowledge of Mental
Illness measure
22% decline on Self-Efficacy measure
28% decrease on Perceptions of Verbal Deescalation
These declines represent a diminishing effect, or
decay, of the training over time.
MEASURING CHANGE OVER TIME:
GROWTH CURVE MODELS (N=117)
Effect
Model 1: Knowledge of Mental Illness
Time 1 (Pretest)
Time 2 (Posttest)
Sex (Female)
Prior Mental Health Training
Volunteer Status
Model 2: Self-Efficacy
Time 1 (Pretest)
Time 2 (Posttest)
Sex (Female)
Model 3: Perceptions of Verbal De-escalation
Time 1 (Pretest)
Time 2 (Posttest)
Race (Non-White)
Rank (Patrol)
Note: **= p <.01
β
SE
-.694**
.031
-.078
-.064
.074
.128
.122
.127
.120
.126
1.27**
5.39**
-1.25
.451
.390
.536
2.545**
3.227**
.234
-.074
.244
.228
.282
.250
Note: Reference categories for variables: Time 3 (Follow-Up), Sex (Male), Prior mental health (Yes), Volunteer status
(Volunteer), Race (White), Rank (Supervisor)
GROWTH CURVE MODELS (N=117)
 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
 Officers’ scores at Time 1 were significantly lower (9%) than Time 3.
 Officers’ scores at Time 2 were slightly greater (<1%) than Time 3.
 Self-Ef ficacy
 Officers’ scores at Time 1 and Time 2 were significantly higher than
Time 3, (5% and 22% respectively).
 Perceptions of Verbal De -Escalation
 Officers’ scores at Time 1 and Time 2 were significantly higher than
Time 3, (21% and 28% respectively).
OFFICER CHARACTERISTICS & TRAINING
EFFECTIVENESS
 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:
•
•
•
•
•
•
Sex
Race
Ethnicity
Rank
Age
Years of Service
• Volunteer Status
• Prior Mental Health
Training
• Know Someone with
Mental Illness
FINDINGS: OFFICER CHARACTERISTICS &
TRAINING EFFECTIVENESS
 Immediate Training Effects:
 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-Efficacy:
 Females gained significantly more than males.
 Verbal De-Escalation:
 No significant differences noted.
FINDINGS: OFFICER CHARACTERISTICS &
TRAINING EFFECTIVENESS
 Intermediate Training Effects:
 Self-Efficacy:
 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.
ADDITIONAL TRAINING FINDINGS
 On follow -up sur vey: Of ficer s were asked how their knowledge &
perceptions of MH ser vices & referral process changed as a result
of CIT training
Measure
Perceptions of MH Services
Worsened
Stayed the Same
Improved
Knowledge of MH Referral
Worsened
Stayed the Same
Improved
Knowledge of MH Services
Worsened
Stayed the Same
Improved
Correctional Officers
N
%
Law Enforcement Officers
N
%
1
15
21
3
40
57
0
16
47
0
25
75
0
18
19
0
49
51
0
15
48
0
23
76
0
14
23
0
38
62
0
9
54
0
14
86
MOST IMPORTANT ASPECTS OF CIT TRAINING
 Over 85% of officers indicated these elements have been
somewhat or ver y 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
OTHER KEY OFFICER FINDINGS
 Nature of Incidents Involving Law Enforcement of ficers:
 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 Of ficers:
 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.
CURRENT STUDY:
PRONG 2- IMPACT OF CIT ON CJ AGENCIES
 Sample:
 Representatives of law enforcement and correctional agencies
that participate in the CIT program in the nine Florida counties
in which officers 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 email
 Analytical Strategy:
 Content Analysis
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:
 13/18 (72%) indicated CIT decreased incidence of officer 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
CORRECTIONAL 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 officer 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.
CIT TRAINING CONCLUSIONS
 The training achieves the intended of ficer -level objectives
measured in this study.
 The training is ef fective for both law enforcement and
correctional of ficers.
 Of ficers experience a significant decline on self -efficacy 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.
 Of ficer sex, race, rank, prior mental health training, and
volunteer status are related to susceptibility to training.
 Law enforcement and correctional of ficers 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 IMPACT ON AGENCIES 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 injury
Use of specialty units (SWAT, cell extraction)
Use of segregation
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