St. Louis Area

Crisis Intervention Team Program
for law enforcement

 Police officers trained in crisis intervention focus on de-escalation strategies and
redirecting individuals when a mental health related crisis is identified.

 CIT Program--More than Just Training 

PROBLEM:  3.5 Million Americans have severe mental illnesses and fewer than 50% receive even minimally adequate treatment.  How many of these underserved people are in your community and how much patrol time do they utilize? 

What Is CIT?

Crisis Intervention Team (CIT) training, developed in Memphis TN, provides a model of specialized law enforcement expertise.  Volunteer officers, based in the general patrol division, work in cooperation with the mental health system, consumers, and families.  Trained CIT Police officers carry on the normal duties of law enforcement, but switch to a specialist role when a potential mental health-related crisis is identified.  CIT focuses on de-escalation strategies, and redirecting the individual from the criminal justice system to the mental health care system.  In turn, the mental health care system assumes “custody” of the individual, and provides directed and non-restrictive accessibility to a full range of health care and social service options.  

How Does CIT Work?

Selected/volunteer police officers take part in a 5 day, 40 hour training program. The program includes mental health and substance abuse experts, legal experts, consumer/family advocates, and experienced CIT officers.  Once trained CIT officers are in place, high-risk crisis calls are directed to an on-duty CIT officer. The CIT officer leads a police-based crisis intervention of generalist officers. The CIT officer, employing a de-escalation intervention strategy, may access BHR crisis services, or transport the individual to a partnered hospital emergency room. The mental health system assumes “custody” and provides a “police-friendly” efficient turn around time for the officer to return to normal patrol duties.

What Is “More Than Just Training”?

Training is more than a “one-shot” deal.  Several times a year, officers meet for debriefing meetings and in-service trainings to problem solve tactical issues, discuss different experiences and scenarios they have encountered, and participate in advanced training.  This allows officers a chance to reinforce and sharpen their skills, address new problems, and build cohesiveness. 

Why Does Our Community Need CIT?

Police are often the first to be called for a crisis situation involving person(s) with a mental illness.  These crisis situations can and have involved officer and citizen injury or deaths in the St. Louis area.  CIT training significantly decreases injuries, death, and community dissent. In turn, person(s) with a mental illness are diverted to the mental health system and treatment rather than to jail or to return to the streets. Citizens become more confident in reporting crisis situations and police officers are better prepared to respond safely to those situations.  Crisis intervention shifts from lose-lose to win-win.

The CIT program is more than just training, it involves a whole process of:

• Three to four trainings a year to maintain CIT officer availability 24 hours a day -7 days a week

• Immediate response crisis intervention from specialized police officers

• 24-7 access to BHR’s crisis counselors and mobile outreach

• Efficient triage and admission to the hospital for individuals in crisis

• Referral to community care

• Four police debriefings a year to track progress and provide support

• Accountability through monthly Coordinating Council meetings to identify and resolve problems

• Ongoing collaboration and dialogue among police, mental health providers, agencies, families, and consumers

• Ongoing police in-service trainings to maintain officer skills and provide advance training

• Research programs to measure program effectiveness and benefits.

Known Outcomes of CIT *

• Increases officer/citizen safety

• Decreases police liability and litigation

• Extends officers’ skills

• Increases on-scene expertise

• Minimizes officer “turn-around” time on calls involving persons in crisis

• Increases officer/community confidence

• Increases professionalism

• Empowers officers to divert person(s) with a mental illness to treatment

• Increases cooperation between criminal justice and mental health systems

• Establishes responsibility and accountability

• Decreases arrest rates

• Reduces recidivism

*  See Steadman, Deane, Borum, & Morrisey, 1998;    Steadman, Morrisey, Borum, & Deane, 1997

Program Benefits (for consumers) 

• Crisis response is immediate

• Arrests and use of force decrease

• Underserved consumers are identified by officers and provided with care

• Patient violence and use of restraints in the ER decreases

• Fewer “victimless” crime arrests

• Decrease in liability for health care issues in the jail

• Cost savings 

• Most importantly, CIT officers give consumers a sense of dignity.  This dignity generates a new respect and outlook on the police and the mental health systems.

How Well Does it Work?

Sgt. Barry Armfield,  a St. Louis County Police Officer for 32 years, with assignments in all patrol divisions including Tactical Operations, reports on the value of CIT in the St. Louis Metro Area.  He currently serves as the CIT Police Liaison Coordinator for the St. Louis County CIT Program.

The Missouri Foundation for Health (MFH) approved a grant to NAMI St. Louis to finance the CIT program in the Greater St. Louis Area. Part of the grant is evaluation of the program and CIT training. Sabrina Tyuse, Ph.D., an Assistant Professor at St. Louis University, is responsible for evaluating the program. She completed a one-year evaluation of the CIT program and results of her evaluation are used in this article. The one-year time period is from July 2005 thru June 2006. She has developed this information from reports I receive from police departments who participate in the CIT program and report the CIT incidents. 

• There were 1,259 reported CIT incidents; 55% involved male consumers and 45% female.
• 65% had a history of mental heath issues.
• Only 9% were compliant with prescribed medications
• 29.5% were under the influence of drugs or alcohol at the time of the intervention.
• 89% (850) were transported to a hospital emergency department or treatment facility.  633 incidents involved the CIT officer completing an affidavit for mental health evaluation.
• Law enforcement officers used some type of force with only 4% (52) of the persons involved in a mental health crisis and there was only one incident involving lethal force.
• There were only 9 reported injuries (bruises and scrapes) to police officers.
• 3% of the individuals in crisis received injuries after CIT involvement.

The CIT program has resulted in more than 600 officers trained in crisis intervention. Dr. Tyuse writes in her report, “Anecdotal reports suggest that CIT law enforcement officers have successfully integrated CIT methods with standard law enforcement officer training procedures, have been effective in intervening with individuals who have a mental illness during mental health crises and have successfully resolved situations on the scene or, when appropriate, have diverted individuals who have a mental illness in crisis to community-based mental health treatment facilities.” 

For more information on CIT, contact me at barmfield@stlouisco.com or call 314-628-5509. We are looking to expand the CIT program and I am available to assist.

The Crisis Intervention Team Model- St. Louis Area 

The St. Louis Area CIT Program is based on the Memphis Model, but has gone through extensive evaluation and revision to make the training program relevant to the needs of the St. Louis area.   

CIT Program Structure 

 Coordinating Council; Chairman, Major Robert Trittler

·        Membership

• Open to police officers, mental health community, families, and consumers.

·        Functions

• To develop and implement CIT Training, Debriefing, and In-service Training

• To identify and resolve any problems that arise along the flow from immediate response crisis intervention to delivery of care

• To partner with Mental Health Court, Jail Diversion, and Family Crime programs

• To offer assistance in the expansion of CIT training to other area police departments

·        Council Committees/Functions

• Executive Committee

§         Core group representing the collaborative effort to coordinate and set agenda for the Coordinating Council

§         Representatives include director of the council, a police officer, BHR representative, NAMI representative and a CIT trainer.

• Provider Relations Committee

§         Works to identify and encourage those hospitals with a psych unit in key geographical areas of the City and County to partner with the CIT Program.

§         Encourages hospitals to work toward efficient hospital triage and directing individuals in crisis to mental health care.

• Training/Curriculum Committees

§         Develops and implements a highly relevant and effective 40 hour post-certified training for the St. Louis area in which CIT officers are trained to more knowledgably and safely intervene with individuals who are in mental illness crisis, de-escalate the crisis situation and direct individuals to appropriate care.

§         Develops and implements ongoing training evaluation, and updating of the CIT training

§         Develops and implements debriefing meetings and in-service training.

• Evaluation

§         Working to obtain grant funding to identify and define the data needed to determine if the program is accomplishing the Model’s proposed benefits of (a) immediate crisis response; (b) decrease in arrests and use of force; (c) underserved consumers identified and diverted to care; (d) reduction in patient violence and use of restraints in the ER; (e) better officer training in de-escalation techniques; (f) reduction in officer injuries; (g) reduction in recidivism; (h) increase in officer recognition and appreciation by the community; (i) decrease in “victimless” crime arrests; (j) decrease in litigation; (k) cost savings

• Mental Health Court/Jail Diversion 

§         Working to partner with the CIT Program to more effectively access Mental Health Court and Jail Diversion Programs.

CRISIS INTERVENTION TEAM TRAINING CALENDAR

St. Louis Area Communities that have CIT trained Officers