LEN salutes its 2000 People of the Year:
The Memphis PD’s Crisis Intervention Team reinvents police response to EDPs
Two years ago, a National Institute of Justice study examining police interaction with the mental health system found that fewer than half of 176 big-city police departments had a specific protocol for handling calls involving emotionally disturbed persons (EDPs). Yet at least two-thirds of those agencies surveyed — regardless of whether they had such a protocol — rated themselves as dealing with such incidents either moderately or very effectively.
“Honestly, I think they’re fooling themselves,” said Dr. Henry J. Steadman, the study’s lead author. “Our research data suggests quite strongly that a specialized response is a qualitative difference, a real significant benefit to the community beyond being sensitized to the issues. There are certain departments that will say, ‘Yeah, we have to do something.’ They’re receptive, but without a really focused, specialized response, they are not doing justice to officers or the community.”
Of three basic strategies identified by the NIJ study for dealing with the mentally ill, one in particular has been hailed by professionals in both the law enforcement and mental health fields as perhaps the single most effective method today for dealing with EDP calls. It involves giving special training to patrol officers to act as first responders and liaisons to the formal mental-health system. This approach has been pushed to the edges of the envelope by the Memphis Police Department, where the Crisis Intervention Team (CIT) developed in 1988 has changed the culture of an agency and helped to protect the welfare of both officers and EDPs.
More than a team
“We have yet, thank God, to be responsible for taking the life of one individual in 11 years at the hands of our Crisis Intervention Team,” said Memphis Police Director Walter Crews. It was Crews who, as the department’s hostage negotiation coordinator in 1988, helped to create the CIT. And it is Crews, along with Lieut. Sam Cochran, the CIT’s coordinator, and Dr. Randy Dupont, head of the psychiatric emergency room at the University of Tennessee Medical Center, who have earned the annual Law Enforcement News honors as People of the Year for 2000.
“It’s really more than a team,” Crews said of the CIT approach. “It’s the spirit of the police department. It’s everywhere.”
The Memphis model, as it has come to be called, was used by just six departments, or 3 percent of Steadman’s sample, when his research team surveyed law enforcement in 1996. Since then, it has been adopted by such forward-thinking law enforcement agencies as Portland, Ore., Albuquerque, Seattle, San Jose, Minneapolis and Waterloo, Iowa, and is under consideration by the Houston Police Department, which launched a pilot program last year, and by the departments in Oxnard and Ventura, Calif.
Police will be the first to say that they are not therapists; many can barely tolerate any suggestion of their being social workers. Yet in recent years, as the volume of people with serious psychiatric problems appears to have grown significantly, near daily confrontations with EDPs have become a maxim of law enforcement across the country.
The New York City Police Department was harshly criticized when officers shot and killed 31-year-old Gidone Busch on Aug. 30, 1999. Diagnosed with bipolar disorder, Busch had been hitting a sergeant in the arm with a hammer when police fired at least 12 shots at him. In Los Angeles, Margaret Laverne Mitchell, 54, was fatally shot on May 21, 1999, after she allegedly lunged at an officer with a 13-inch screwdriver. Mitchell, who had been living on the street, had a long history of mental illness.
In effect, police have become the “front-line crisis respondents” in many jurisdictions, as access to beds in public-sector psychiatric facilities has narrowed and been replaced by out-patient care, said Ron Honberg, director of legal services for the National Alliance for the Mentally Ill (NAMI).
“It’s really a reflection of the lack of appropriate treatment options for people,” he told LEN. “Hospital beds are frequently in short supply and mental health programs in the community have been decimated, or never materialized,” said Honberg. “Or, if they’re good, they aren’t properly designed to meet the needs of the sickest individuals. Police are called on more and more to respond to people. Though I couldn’t quantify it, I think the problems are worse.”
In Memphis, uniformed patrol officers are trained as specialists to respond to mentally ill subjects, referred to as consumers by the department. When they are not handling such calls, the 190 officers in the CIT unit — nearly 10 percent of the force — perform their regular patrol duties so there is at least one specialist available for each shift throughout the agency’s seven precincts. Should a precinct’s CIT officer be out on regular call, MPD dispatchers maintain a data base so they can send out whichever officer is assigned to the next precinct closest to the scene, regardless of geographical boundaries.
Each year, the department handles approximately 6,000 mental disturbance calls, said Crews, and transports about 5,000 people to the emergency room — generally when they are at the height of their acting out, he said.
Two fatalities in 1987 involving emotionally disturbed subjects acted as the catalyst for the program. On Sept. 24, police responded to a call about a man who had slashed himself more than 100 times with a butcher knife but was still very aggressive. He was fatally shot when he lunged at officers. Several weeks later, a subject who had been acting out violently was hit on the head with a nightstick and died. Although the medical examiner concluded that the subject had actually died from ingesting cocaine, the episode was viewed by the community as an act of police brutality.
Those events, said Crews, helped to hasten a process that had been underway since 1986 to find a better way to deal with the mentally ill.
“Having both those occasions back-to-back, we accelerated a program that we had already begun,” said Crews, who chaired the task force. “With the help of the mayor at the time, we summoned to the table leading mental health authorities and other caretakers, established a dialogue and a business conception for about seven or eight months that resulted in an articulated training program for the police that we termed Crisis Intervention Team.”
Time is of the essence
Cochran said the state’s Alliance for the Mentally Ill (AMI), one of the partners in the task force, was insistent that any plan address the issue of immediacy. “They realized that it may take a while to get an individual who is an expert down to the scene and quite frankly, that’s true,” he told LEN. “It’s hard to move people from one location to another, especially if this is during rush hour or late at night. Often times, officers do not have the luxury of waiting until there is a professional person at the scene. The committee came to the conclusion that the only people who can arrive with immediacy is law enforcement itself.”
The response time for a CIT officer on a crisis call is an average of 5 to 10 minutes, said Dr. Dupont, as compared with other models where police took 30 to 50 minutes.
Having such a unit within the patrol division was not only cost-effective, noted Cochran, but also made sense from an operational standpoint. Since most mental disturbance calls are going to be assigned initially to a patrol unit, why not make those officers the first responders? “We were going to have a specialized unit that was really kind of unique for the uniformed patrol division,” he said.
Immediacy and training, Crews told LEN, are the two components that make the program different.
CIT officers are all volunteers who undergo a 40-hour multidisciplinary training curriculum provided at no cost to the city by mental health professionals, legal experts and family advocates. The officers undergo an extensive background check, Cochran said, and not all volunteers make the cut. He likened it to trying out for any specialized unit, such as the SWAT team, where the training is dynamic and the materials and instructors are superior.
No more John Wayne
Once in the unit, said Crews, they are taught a variety of verbal and non-verbal techniques for defusing a situation, such as neurolinguistic programming, which lowers anxiety. Trainees also talk to hospitalized patients who have had police respond at their homes, asking them what would have helped to bring them under control at the scene.
“We did away years ago with what I call the John Wayne approach, which is my terminology for charging,” said Crews. “We took on what I call the Mother Theresa approach.”
According to Dupont, who is a clinical psychologist and professor at the University of Tennessee, barricade situations are rarely left to develop, but when they do, CIT officers are the first responders who try to talk the person into cooperating.
While supervisors retain their authority, the CIT specialists are in charge of the call, said Cochran. If they are not successful, the department sends in its hostage negotiators. They will bivouac at the site and have a go at the situation for hours. After that, if police determine the subject is armed, the tactical unit is called in and a perimeter set up.
“A lot of the time, police administrators, when they hear that,” said Cochran, they think, ‘You mean you’re usurping the authority of supervisors?’ I don’t mean that at all. Supervisors still have authority, but in most situations, supervisors don’t go along on mental disturbance calls unless there’s some aggravating circumstances that might require their presence.
Even then, he said, “the luxury is that we have a specially trained officer.”
A whole lot safer
Data which Dupont has been compiling as part of a study for the Substance Abuse and Mental Health Services Administration (SAMSA) on jail diversion initiatives suggest that CIT decreases the need for hostage negotiations and tactical squads. It also indicates, that the officer injury rate was seven times higher before the implementation of the CIT program. Looking at current rates of injury and comparing it to all calls, including false alarms with no interaction, said Dupont, officer injury rates from calls involving EDPs are not statistically different at this point from any other calls. “If you go back in time,” he said, “they were highly different.”
Also significantly reduced have been barricade call-outs, said Cochran. “Not all barricades involve mental illness, but a number did. What is happening is that when our officers respond to situations which could very easily escalate into a barricade situation, they are able to defuse it, which is a tremendous savings to the city. I think if they are resolving these things on the front end, there is a tremendous savings.”
It is not appropriate for police to act as surrogate treatment providers for the mentally ill, said Honberg, but the reality is that as police walk their beats each day, they are going to respond to an increasing number of people in psychiatric crisis. “There has to be some sort of capacity in the police department to recognize the signs and symptoms of mental illness and respond in a way that defuses rather than inflames people,” he said. “That’s what they seem to do so well in Memphis. They know how to calm people down and prevent tragedies.”
The other key factor in the program’s success is Dupont’s psychiatric emergency room at the University of Tennessee Medical Center, known as “The Med.” Instead of officers having to wait six hours or more after taking someone into custody, the turnaround for CIT officers can be as little as 20 minutes. Evaluations for patients are done within 24 hours. Dupont said Shelby County had made a commitment that it would provide services for law enforcement that were different from many emergency rooms. One of the single biggest factors in the criminalization of the mentally ill, he said, is the way in which mental health facilities require police to be “baby-sitters or transportation agents.”
Steadman, in a follow-up to his NIJ study “Police Perspectives on Responding to Mentally Ill People in Crisis: Perceptions of Program Effectiveness,” found that CIT officers gave a higher rating to their community’s mental health system than did police in Birmingham, Ala. or Knoxville, Tenn. Both cities have specialized police response programs for the mentally ill, but neither are of the same model as is found in Memphis.
The ‘one-stop drop’
Birmingham has what Steadman identified as a police-based specialized mental health response, which uses mental health consultants hired by the department for on-site and telephone consultations. Knoxville uses a mental-health based specialized response, in which agencies rely on mobile crisis teams that are part of community mental health service systems that have a developed a special relationship with police. They typify the other two models found most often in agencies with protocols for handling EDPs.
“Having a ‘one-stop drop off’ center,” said Steadman’s follow-up study, “would appear to be a crucial element in reducing officer down time in responding to mentally ill people in crisis. Reducing down time may then reduce the likelihood that an officer would resort to arrest or non-action as a more time-efficient means of disposition.
“The importance of minimizing officer time should not be underestimated when developing specialty response programs,” the study emphasized.
Dupont has made it as easy for police to drop the “consumer” off at The Med as it is to deliver them to the jail. “We try to provide basically a cooperative relationship involving ourselves with them,” he said. “That’s why we got involving with the training. We simply accept the referrals without any of the restrictions other than that we have a different emergency room for those under criminal charges.”
Easy access to mental health facilities is crucial in keeping the mentally ill out of county jails, agreed Cochran. When a person who is in crisis is taken into custody, the prospect of a five- or six-hour wait before that individual can be received by the system could make the officers decide to deliver the individual to jail with a charge of disturbing the peace or disorderly conduct.
“Resistance to law enforcement usually means officers will choose the easier course of action,” said Cochran. “Many times, police act on reasonableness. What did the police know within the environment in which he is responding to this call? What is in the community? Police have a very keen sense of being to articulate the facts and assess them — and make good decisions about the outcome.
“But if the officers cannot utilize their time to access services, that’s when they say, ‘Well, this is disorderly conduct.’ They will take that person to the county jail,” Cochran continued. “They will reason that they will access mental health services through there. Now, there is something inherently wrong with that, but I understand that officers are forced into that situation. And I mean that, forced.”
A Justice Department report last year found that in 1999, approximately 16 percent of inmates in state prisons and local jails — a total of roughly 283,800 — could be classified as mentally ill. Another 7 percent of federal inmates fit that description. Mental illness among local jail inmates is about twice that of the general population.
What has tended to set the CIT program apart is how it has changed the culture of the Memphis Police Department, agreed Crews and Dupont. By embedding the initiative in the patrol division, said Dupont, the department was able to reach far more officers than would have been the case if the unit was more isolated. “We’re reaching out, getting 15 to 20 percent of the entire patrol division, guys who are in the squad room with the other people, who know each other personally,” the doctor observed.
The subliminal effect on the departments that have adopted CIT, said Crews, has been that the mentally ill are seen as sick and not criminal. In training CIT officers, he said, “we take our time and more than anything else, we learn what empathy is all about. You got to walk in the other person’s shoes.”