Schizophrenia and the Criminal Justice System: The Benefits of Crisis Intervention Team Training
My last blog discussed some of the research that has been done on the risk of violence associated with people with schizophrenia, so in this entry I decided to discuss some of the interactions people with serious mental illness have with the criminal justice system.
In the last two decades there have been several efforts to improve the services available for people with serious mental illness who become involved with the police. These efforts include training of police officers, diversion programs in jail, mental health courts, and reentry programs for people once they are released from correctional facilities. Since each of these topics is a robust area of discussion, I will focus this blog entry on police officer training to handle calls from people in crisis.
One study of 194 U.S. cities published in 1999 showed that roughly seven percent of police complaints and investigations involve a person suspected of having a mental illness. However, the same study indicated that less than half of these cities had a specialized protocol for responding to people with psychiatric illness. Over the last two decades there have been increasing efforts to expand such programs, as research demonstrates the benefits for patients, the police officers involved and society as a whole.
One such program is crisis intervention team (CIT) training of police officers. Most modern CIT programs get their design from a project begun in 1988 by the Memphis Police department, the University of Memphis, the University of Tennessee, and the National Alliance for the Mentally Ill. It is designed to give police officers information on mental illness and train them in ways to improve responses to people with psychiatric disorders, including schizophrenia.
The program involves 40 hours of training that lead to certification as specialized first-responders for crisis calls. Training includes information on mental illness and information on how to deescalate potentially violent scenarios. Part of the program includes enhancing the partnership between police and psychiatric emergency departments in order to increase the likelihood that people experiencing a psychiatric emergency are taken to these facilities as opposed to jail.
It doesn’t sound like there’s much to this process, but several studies published over the last few years indicate that CIT programs reduce the use of police force in the community, decrease the number of unnecessary arrests, and increase referrals to health care services. The effectiveness of these programs helps to reduce more costly alternatives, like prolonged incarceration. Another result of the CIT programs is a greater understanding of the aggressive behaviors people with schizophrenia sometimes have, which helps reduce stigmatization of the illness among police officers.
I work regularly in a crisis center, and I am consistently overwhelmed by the number of people walking through the door in police custody who suffer from severe schizophrenia, and have never before been treated. Unfortunately, people with severe schizophrenia often fail to receive treatment until they interact with the criminal justice system. The Memphis model of CIT is a step in the right direction, and lawmakers have been doing their part as well. In recent years, several laws have been enacted to increase the funding towards improving the relationship between mental health systems and law enforcement, most notably the Mentally Ill Offender Treatment and Crime Reduction Act of 2004 (S.1194). It is my hope that one day, people suffering from schizophrenia will be able to receive the treatment they need without interacting with the criminal justice system first.
Paul Ballas, D.O., wrote about mental health for HealthCentral. He is a member of the American Psychiatric Association and has been a presenter at the American Psychiatric Association and American Academy of Psychosomatic Medicine meetings.