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Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals’ first two arrests and most recent two arrests.A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia.A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction–related charges, and disorderly conduct.Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients’ legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).

The Crisis Intervention Team (CIT) model has been implemented in over 3,000 communities across the USA. Research to date has shown beneficial results in terms of officers’ knowledge, attitudes, self-efficacy, stigma, and force preferences. This study aimed to broaden the lens on the implementation context of CIT to examine whether factors in the environment and response process affect how calls are resolved. This study focused on several factors—CIT response, call location, and upstream decisions to pre-identify calls as mental health-related—that may impact call outcomes. Our findings suggest that CIT response, dispatch coding, and the places where calls originate play a role in shaping outcomes. More research is needed to unpack the effects of this wider CIT implementation environment.

Reducing the overrepresentation of individuals with serious mental illnesses in the criminal legal system requires a better understanding of the charges for which they are most commonly arrested. This study aimed to compare violent offenses, penal code classifications, Uniform Crime Reporting (UCR) codes, and specific charges in arrests among individuals with and individuals without serious mental illnesses.The authors analyzed all arrests (N=2,224,847) in New York State during 2010-2013. Medicaid data and the state mental health authority's records were used to create an indicator of serious mental illness for each arrest.Among arrests involving individuals with the serious mental illness indicator (N=91,363), 7.3% were for violent offenses, compared with 7.6% of arrests involving individuals without the indicator. Among 10 penal code classifications, class B felonies and class A misdemeanors were more likely in arrests among those with the indicator than among those without it. Of the 14 UCR codes examined, seven were more common in arrests with the serious mental illness indicator. Criminal trespass was among the most common charges in arrests involving individuals with the indicator.Most arrests involving people with serious mental illnesses were for misdemeanors, specifically class A misdemeanors, and this class comprised a larger proportion of arrests for those with the indicator than of arrests for those without it. New approaches are needed to address the situations-usually related to socioeconomic disadvantage-that result in individuals with mental illnesses receiving misdemeanor charges and cycling through the criminal legal system.

WHAT IS KNOWN ON THE SUBJECT?: People with serious mental illnesses are overrepresented in the criminal justice system. Interventions such as Crisis Intervention Teams and Co-responder Teams may improve police officers' ability to provide effective response. There is still a gap in our knowledge of the nature of the situations officers are responding to and their perceptions of what is needed for effective response. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides insight into officer perceptions and experiences of the mental health-related calls they respond to involving youth, adults and families. Officers often refer to people in crisis as having "gone off meds" but also recognize more complex factors at the individual level (e.g., co-occurring issues), family level (challenges of caring for a loved one with mental illness) and community level (deficiencies in health and social resources to address long-term unmet needs). Deficiencies in the resources needed to address the unmet needs of people and their families frustrate officers' desires to make a difference and effect long-term outcomes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Findings underscore the need for cities and communities to develop alternatives to emergency departments which, in the long term, may provide the best hope for reducing the reliance on police as mental health interventionists. Formal collaborations between the law enforcement community and the mental health nursing community could be focused towards this end. Findings provoke the larger question of what should "count" as good police work in the face of deficient community health systems. Practitioners should consider the distinction between police effectiveness and "whole system" effectiveness. Police officers could be held to account for "principled encounters" that are resolved in ways that reduce immediate harm, avoid stigma and advance procedural justice, but the full impact of their effects is contingent on the capacity of the wider system to do its job. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health-related situations. ABSTRACT: Introduction Data on fatal outcomes of police encounters, combined with evidence on the criminalization of people with mental illnesses, reveal a grave need to improve outcomes for individuals with mental illnesses who come into contact with police. Current efforts are hampered by a lack of in-depth knowledge about the nature of nature and context of these encounters. Aim/Question Building on previous findings from a larger study on the nature and outcomes of mental health-related encounters with police in Chicago, this paper examines officer perspectives on the unmet needs of individuals and their families and the ways in which the mental health and social system environment constrain officers' abilities to be responsive to them. Methods Findings are drawn from qualitative data produced through 36 "ride-alongs" with police officers. Field researchers conducted open-ended observations of police work during routine shifts and carried out interviews with officers-according to a ride-along question guide-during periods of inactivity or between calls for service to ask about experiences of mental health-related calls. Field notes describing their observations and ride-along interviews were analysed inductively using a combination of open and focused coding. Results Officers responded to a variety of mental health-related calls revealing complex, unmet needs at individual and family levels. A common theme related to officers' perceptions that "going off meds," combined with other situational factors, resulted in police being involved in behavioural health situations. The data also revealed broader aspects of the health and social system that, in officers' minds, constrain their ability to effect positive outcomes for people and their families, especially in the long term. Discussion Findings beg the larger question of what it is we, as a society, should expect of police in the handling of mental health-related calls, given their concerns with the wider health and social service system that they experience as deficient. At the same time, the view that "going off meds" is a common trigger of mental health-related events should be interpreted with care, as it may signal or perhaps serve as a shorthand for more complex health and social needs that could be obscured by a pharmacological or medicalized perspective on mental illness. This is an important area of future inquiry for research at the intersection of policing and mental health nursing. Implications for practice The contribution of police to the wellness and recovery of people and their families is constrained by the ability of the community health and social service system to do its job. A wave of new initiatives designed to enhance the interface between police and the medical community holds out hope for alleviating officers' concerns about whether they can work in tandem with the rest of the system to make a difference. For now, we suggest that what we can expect of police is to implement "principled encounters" that ensure public safety while achieving harm reduction, self-determination and the reduction of stigma. Mental health nurses are well positioned to assist with officer training and provide support to officers responding to mental health-related situations. However, the fields of policing and nursing practice may not yet fully understand the individual, family and community dynamics driving calls for police service. The notion of "gone off meds" should be interrogated as a potential trope that obscures a whole-of-person approach and whole-system approach to mental health crisis response and care.

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 perception 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.

In 2017, The Kennedy Forum Illinois partnered with the City of Chicago and community partners to launch the West Side Community Outreach Pilot Project, an initiative designed to bring free mental h...

Calls to defund and reform police agencies have been emphasized in recent public discourse. Demands range from shuttering police agencies to shifting resources and responsibility for responding to noncriminal social and behavioral health vulnerabilities to the health and social services sector. This Open Forum discusses how police officers became primary responders to behavioral health concerns, how this arrangement disproportionately and negatively affects communities of color, and several solutions to these circumstances. The mental health field must advocate for the policies and resources needed to address urgent mental health needs and crisis response. Several conditions for successful outcomes that do not further compound racial inequities are discussed.

Prior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied.251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit.An alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics.CIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.

The Theory of Planned Behavior posits that behaviors are predicted by one’s intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers’ intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22 months after training, have significantly higher scores on those factors.

The authors examined how police officers assess for mental illnesses and how those assessments vary by location. Researchers conducted semistructured interviews with 15 officers working in two poli...

In recent decades, there has been sustained attention on police responses to persons experiencing mental health crises. The Crisis Intervention Team (CIT) model has been a seminal effort to improve safety, reduce arrests and enhance the use of emergency psychiatric assessment. With CIT well-established, new discussions have emerged around how to further enhance the police-public health interface, including diversion from hospital emergency departments. In this context, this paper takes stock of current police practices, utilizing descriptive data on 428 mental health-related calls addressed by Chicago Police over 3 years triangulated with insights from 21 in-depth officer interviews. During these calls, hospital transports were conducted more often than arrests. Moreover, informal interventions - without any legal action or hospitalization – were used most often, speaking to the “gray zone” (Wood, Watson & Fulambarker, 2017) nature of mental health-related encounters. Taken together, the data reveal the need for non-crisis diversion options that address chronic vulnerabilities.

As academic researchers, we are often asked to opine on whether the Crisis Intervention Team model (CIT) is an evidence-based practice (EBP) or evidence-based policing. Our answer is that it depends on how you define evidence-based practice and what outcome you are interested in. In this commentary, we briefly describe the CIT model, examine definitions of evidence-based practice and evidence-based policing, and then summarize the existing research on what is known about the effectiveness of CIT to date. We conclude that CIT can be designated an EBP for officer-level cognitive and attitudinal outcomes, but more research is needed to determine if CIT can be designated an EBP for other outcomes. Using an evidence-based practice process approach, CIT may also be a justified strategy for many communities. Future directions to inform the field are discussed.

Purpose The purpose of this paper is to propose a focus for mental health training efforts to better equip officers to provide interventions and supports to help facilitate improved outcomes for people experiencing mental health crises. Design/methodology/approach A reflection on key evidence relating to mental health training programmes delivered to police, focussing on Australia, the USA and Canada. Findings While there are a number of similarities in the core content of mental health training programmes offered internationally, the availability and uptake of training across jurisdictions remains piecemeal and idiosyncratic. Police officers report a strong preference for hands-on experiential learning; this has immediate and direct relevance to their operational duties, and is consistent with core principles of andragogy. While all police employees require mental health training, specialised mental health training programmes should clearly be reserved for a select group of officers who volunteer after acquiring sufficient operational experience. Research limitations/implications Priorities should centre on measuring the effectiveness of mental health training packages and discerning the active elements associated with changes in police skills and confidence, as well as identifying elements that support improved outcomes for people who experience mental illness and who have contact with the police. Practical implications Police need to continue to need to seek legitimacy with respect to their guardianship role as mental health interventionists. Training should tap into practice-based wisdom. Training should be practical, applied and reinforced through wider knowledge-based learning and workplace reinforcement. Training is needed for everyone, but specialised training is not for all. Police need to focus on the partnerships and expend time, energy and resources to maintain and grow them. Specialist (and other forms of) training needs to be evaluated so we understand what works? Originality/value There may be opportunities to streamline the delivery of knowledge-based aspects of mental health training and focus much more on experiential learning, both in specialised training courses as well as shorter mental health awareness sessions.

Developed over 30 years ago, the Crisis Intervention Team model is arguably the most well-known approach to improve police response to individuals experiencing mental health crisis. In this article, we comment on Rogers and colleagues' review (in this issue) of the CIT research base and elaborate on the current state of the evidence. We argue that CIT can be considered evidence based for officer level outcomes and call level dispositions. We then discuss the challenges that currently make it difficult to draw conclusions related to arrest, use of force, and injury related outcomes. More research, including a randomized, controlled trial is clearly needed. But we caution against focusing narrowly on the training component of the model, as CIT is more than training. We encourage research that explores and tests the potential of CIT partnerships to develop effective strategies that improve the mental health system's ability to provide crisis response and thus reduce reliance on law enforcement to address this need.

Individuals with serious mental illness are overrepresented in correctional populations. However, little is known about the representation of persons with serious mental illness at earlier stages in the criminal justice process. This research sought to measure the prevalence of arrestees in New York State who were treated for a major mental illness in the year before their arrest and to assess whether these individuals had a disproportionate rate of incarceration.Approximately 600,000 individuals arrested in New York State between January 1, 2010, and December 31, 2013, were matched against public mental health records to identify defendants diagnosed as having a major mental illness in the 12 months before their arrest.Between 4% and 6% of the arrestees were diagnosed as having a major mental illness during a mental health service visit in the 12 months prior to their arrest. A major mental illness diagnosis was associated with more than a 50% increase in the odds of a jail sentence for misdemeanor arrestees, after the analyses controlled for the other case characteristics. Conversely, it was unrelated to the likelihood of a prison sentence given a felony arrest, but it did moderate the effect of other case characteristics within the group of arrestees with felonies.Differential adjudication of misdemeanor arrestees with a major mental illness diagnosis appears to contribute to their overrepresentation within the jail population. The role that poverty and pretrial incarceration may play in this relationship was not explored in this research and should be the subject of future investigation.

Stigma is a significant barrier to recovery and full community inclusion for people with mental illnesses. Social work educators can play critical roles in addressing this stigma, yet little is known about their attitudes. Social work educators were surveyed about their general attitudes about people with mental illnesses, attitudes about practice with people with mental illnesses, and attitudes about students with mental illnesses. On average, educators’ general and practice attitudes were not negative. However, respondents did view a student with a mental illness differently from a “typical social work student.” Findings suggest that we, as social work educators, must raise our awareness and address our own attitudes to support students and uphold our social work values.

While Assertive Community Treatment (ACT) is considered an evidence-based service model, there is limited evidence regarding the effectiveness of an adaptation of the model, Forensic Assertive Community Treatment (FACT), for persons with serious mental illness who also have significant criminal justice system involvement. Using a multimethod approach, this article combines quantitative and qualitative data to review baseline information and nine-month follow-up recidivism, hospitalization, and housing outcomes for individuals enrolled in a FACT program. Findings suggest substance use, housing, and FACT team members’ support played an important role in clients’ prison reentry experiences.

There are calls across America for police to re-imagine themselves as "guardians" rather than "warriors" in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a "case-based" focus with a "place-based" focus.

Although improving police responses to mental health crises has received significant policy attention, most encounters between police and persons with mental illnesses do not involve major crimes or violence, nor do they rise to the level of requiring emergency apprehension. Here, we report on field observations of police officers handling mental health-related encounters in Chicago. Findings confirm that these encounters often occur in the "gray zone", where the problems at hand do not call for formal or legalistic interventions including arrest and emergency apprehension. In examining how police resolved such situations, we observed three core features of police work: (1) accepting temporary solutions to chronic vulnerability; (2) using local knowledge to guide decision-making; and (3) negotiating peace with complainants and call subjects. Study findings imply the need to advance field-based studies using systematic social observations of gray zone decision-making within and across distinct geographic and place-based contexts. Policy implications for supporting police interventions, including place-based enhancements of gray zone resources, are also discussed.

This article describes the innovative use of a pop culture source-song lyrics to augment the teaching of qualitative methods in social work research. The use of pop culture sources as learning tools in the MSW curriculum has the potential to enhance the learning experience for students. These techniques have not been applied in the content of MSW research classes. This approach could be advantageous over other typical data sources because it is more accessible to students while also being reflective of a collective identity of people in society. Future work should assess student and educator responses to this pedagogical approach.

Two surveys were conducted on the crisis intervention team (CIT) model, a police-based program designed to improve responses to individuals with mental illnesses.Data were collected between July and September 2013 from 171 police chiefs and sheriffs (42 had implemented CIT in their agency), and 353 law enforcement officers (273 had CIT training) in Georgia.Police chiefs and sheriffs reported barriers to implementing CIT, such as not having enough officers and insufficient access to mental health services. CIT-trained officers differed from non-CIT-trained officers only with regard to being less likely to use force in response to a man with psychotic agitation described in a vignette, when the analysis controlled for whether the officer carried an electronic control device.Some hypothesized differences, such as in job satisfaction and work burnout, were not observed. However, CIT-trained officers appeared to be less likely to revert to force in a situation involving psychotic agitation.

Drawing on attribution theory, research on police discretion, and public attitudes toward mental illness, we examine attributional processes in police decision making in response to domestic violence situations involving veterans and nonveterans with signs of mental illness. Using data from experimental vignettes varying veteran status, victim injury, and suspect compliance administered to a sample of 309 police officers, the results indicate that 1) veterans are perceived as less responsible for troublesome behavior but more dangerous than nonveterans, 2) suspects’ veteran status has a significant effect on officers’ preference for mental health treatment versus arrest, and 3) part of the effect of veteran status on officer response is mediated by internal and external attributions for problematic behavior and by perceptions of dangerousness. The study empirically demonstrates countervailing processes in police decision making—recognition of the causes for troublesome behavior and the need for mental health treatment on the one hand and concern for community safety and enforcing the law on the other.

Officers' volunteering for Crisis Intervention Team (CIT) training—rather than being assigned—is assumed to be an important, beneficial self-selection bias. This bias remains poorly characterized, though CIT officers are more likely to be female and to have had exposure to the mental health field. We determined whether or not self-selection is beneficial with regard to knowledge, attitudes, and skills, as well as level of force used (i.e., no or low force versus any form of physical force) and disposition of subjects, in actual encounters. We compared CIT-trained officers who had volunteered with those who had been assigned using data from two prior, linked studies that compared CIT-trained and non-CIT officers on knowledge, attitudes, and skills (251 CIT-trained officers; 68% had volunteered), as well as behaviors (517 actual encounters provided by 91 CIT-trained officers; 70% had volunteered). Of 28 scores on knowledge, attitudes, and skills compared, six were statistically significantly different (p

Police officers frequently respond to calls involving persons with mental illnesses and in doing so, they are key gatekeepers of access to mental health treatment as well as entry into the criminal justice system. Programs such as Crisis Intervention Teams (CIT) are being implemented across the United States and elsewhere to train officers to respond more effectively and facilitate access to mental health services when appropriate. These programs would benefit from a thorough understanding of these encounters from the perspective of police officers. We take as a premise that officers develop frames of reference or “schema” for understanding and responding to these encounters that are shaped by socialization, training, and their experience as police officers. In this study, we examine police officer schema of mental/emotional disturbance (M/EDP) calls. Qualitative interviews provided the foundation to develop the Needs on the Street Interview (NOSI) to tap officer schema of four types of M/EDP scenarios. The NOSI was administered to 147 officers in Chicago and Philadelphia. Latent Class Analysis (LCA) was conducted separately for each scenario to examine groups of officers with different schema as well as predictors of schema group. For three of the four scenarios, officers were classified into a two category or schema model, for the fourth (crime reported) a three category model was supported. Schema groups tended to be differentiated by ratings of level of resistance/threat and substance use. Contrary to our expectations, CIT and law enforcement experience did not predict officer schema group. While the CIT model emphasizes de-escalation skills to reduce resistance and the need for officers to use force, CIT and other training programs may want to consider increasing content related to factors such as co-occurring substance use and managing resistance.

Objective Police officers' decisions and behaviors are impacted by the neighborhood context in which police encounters occur. For example, officers may use greater force and be more likely to make arrests in disadvantaged neighborhoods. We examined whether neighborhood characteristics influence police encounters with individuals suspected to have a serious mental illness, addictive disorder, or developmental disability. Method We obtained data on 916 encounters from 166 officers in six jurisdictions in Georgia, USA and abstracted geographical data pertaining to the location of these encounters from United States Decennial Census data. Encounters were nested within 163 census tracts. Officer-reported data covered general encounter characteristics, the officer's perception of the subject's condition, subject demographics, use of force, and disposition of the encounter (e.g., arrest v. referral or transport to treatment services). Geographical data included 17 variables representing population and housing characteristics of the census tracts, from which three indices pertaining to neighborhood income, stability, and immigration status were derived using factor-analytic techniques. We then examined associations of these indices with various encounter-related variables using multi-level analysis. Results Encounters taking place in higher-income and higher-stability census tracts were more likely to be dispatch-initiated and take place in a private home compared to those in lower-income and lower-stability neighborhoods. In higher-income neighborhoods, encounters were more likely to involve a subject suspected to have a mental illness (as opposed to an addictive disorder or developmental disability) and less likely to involve a subject suspected to have alcohol problems. The officer's level of force used was not associated with neighborhood factors. Regarding disposition, although the likelihood of arrest was unrelated to neighborhood characteristics, encounters taking place in higher-immigrant neighborhoods were more likely to result in referral or transport to services than those in lower-immigrant neighborhoods. Conclusion Neighborhood characteristics are important to consider in research on police interactions with individuals with serious mental illnesses, addictive disorders, or developmental disabilities. Such research could inform departmental training policies and procedures based on the needs of the jurisdictions served.

The crisis intervention team (CIT) model is a widely implemented police-based program to improve officers' responses to individuals with behavioral disorders. The authors examined levels of force used by officers with or without CIT training and disposition decisions in a large sample of encounters with individuals whom they suspected of having a serious mental illness, a drug or an alcohol problem, or a developmental disability.A total of 180 officers (91 with CIT training and 89 without) in six departments reported on 1,063 encounters, including level of force and disposition (resolution at the scene, referral or transport to services, or arrest).CIT training status was generally not predictive of level of force, although CIT-trained officers were significantly more likely to report verbal engagement or negotiation as the highest level of force used (odds ratio [OR]=2.00, p=.016). For CIT-trained officers, referral or transport was a more likely outcome (OR=1.70, p=.026) and arrest was less likely (OR=.47, p=.007) than for officers without CIT training; these findings were most pronounced when physical force was necessary. Analyses of disposition differences by officers' perceptions of subjects' primary problem (for example, mental illness only versus a drug or an alcohol problem) found some effects of CIT training status.CIT training appears to increase the likelihood of referral or transport to mental health services and decrease the likelihood of arrest during encounters with individuals thought to have a behavioral disorder. Research should address subject- and system-level outcomes that complement this early evidence of successful prebooking jail diversion.

OBJECTIVES: The Brief Jail Mental Health Screen (BJMHS) is widely used at intake in county jails to identify detainees who may have serious mental illness and who should be referred for further mental health evaluation. The BJMHS may be administered multiple times across repeated jail bookings; however, the extent to which results may change over time is unclear. To that end, we examined the odds of screening positive on the BJMHS across repeated jail bookings. METHODS: Data were drawn from the administrative and medical records of a large, urban county jail that used the BJMHS at jail booking. The study sample comprised BJMHS results for the 12,531 jail detainees who were booked at least twice during the 3.5-year period (total N=41,965 bookings). Multilevel logistic modeling was used to examine changes over time overall and within the four decision rules (current psychiatric medication; prior hospitalization; two or more current symptoms; referral for any other reason). RESULTS: Results show that the odds of a positive screen overall increase with each jail booking, as do the odds of referral for any other reason. In contrast, the odds of screening positive for two or more current symptoms and prior hospitalization decrease. There was no change in the odds of screening positive for current psychiatric medication across bookings. CONCLUSION: Findings show that BJMHS results change across bookings. Further research is needed to determine whether changes reflect true changes in mental health status, issues with fidelity, the repeated nature of the screening process, or other factors.

PurposeThe purpose of this paper is to examine the predictors of officer attitudes toward Crisis Intervention Teams, a new innovation designed to improve police response to people with mental illnesses.Design/methodology/approachThe current study uses data from a larger study of the Chicago Police Department (CPD) Crisis Intervention Team (CIT) program. CIT and Non‐CIT officers were surveyed in four districts. To examine the predictors of officer perceptions of crisis intervention teams, OLS regression is used.FindingsNeither CIT nor non‐CIT officers seem to show the kinds of negative views of CIT that have undercut other social welfare based police innovations. Among CIT trained officers, those who had the opportunity to practice their new skills by responding to mental health related calls for service had more positive attitudes toward the program than those who did not.Originality/valueThis paper adds to both the Crisis Intervention Team and innovation literatures by examining an important aspect of the CIT implementation process. A model is developed that explores the correlates of officer support for the innovation and the conditions necessary for its successful implementation.

There is mounting evidence that mental health courts (MHCs) reduce criminal recidivism and increase use of mental health services. Although not yet empirically tested, procedural justice has been proposed as one potential mechanism that promotes change and improves outcomes for MHC participants. In this article, we investigate MHC participants’ perceptions of procedural justice in interactions with MHC staff as well as the role of procedural justice in participants’ MHC program experiences. Participants from two MHC programs were invited to complete quantitative measures and a semistructured interview about their MHC experiences and perceptions of procedural justice. Univariate and bivariate analyses and qualitative analysis were used to examine the data. Findings indicate that MHC participants perceive a moderate level of procedural justice in interactions with MHC team members. However, perceptions of procedural justice are complex, involve multiple actions and inaction, and are affected by all members of the MHC team, not just the judge. Although scores on quantitative measures of procedural justice do not differ by court, participant perceptions discussed in semistructured interviews do vary. Implications for practice, policy, and research are discussed.

The internalization of public stigma by persons with serious mental illnesses may lead to self-stigma, which harms self-esteem, self-efficacy, and empowerment. Previous research has evaluated a hierarchical model that distinguishes among stereotype awareness, agreement, application to self, and harm to self with the 40-item Self-Stigma of Mental Illness Scale (SSMIS). This study addressed SSMIS critiques (too long, contains offensive items that discourages test completion) by strategically omitting half of the original scale’s items. Here we report reliability and validity of the 20-item short form (SSMIS-SF) based on data from three previous studies. Retained items were rated less offensive by a sample of consumers. Results indicated adequate internal consistencies for each subscale. Repeated measures ANOVAs showed subscale means progressively diminished from awareness to harm. In support of its validity, the harm subscale was found to be inversely and significantly related to self-esteem, self-efficacy, empowerment, and hope. After controlling for level of depression, these relationships remained significant with the exception of the relation between empowerment and harm SSMIS-SF subscale. Future research with the SSMIS-SF should evaluate its sensitivity to change and its stability through test-rest reliability.

The goals of Crisis Intervention Team (CIT) programs include improving safety during encounters between police and persons with mental illnesses, diverting persons with mental illnesses away from the criminal justice system, and increasing referral and access to mental health services. CIT is a systemic intervention, and as such, its implementation and effectiveness are influenced by existing practices and infrastructures. However, little research has considered the context in which CIT programs are implemented. In this paper, we present research on CIT in four Chicago police districts that vary in terms of two contextual factors hypothesized to influence the impact of CIT training on how calls involving persons with mental illnesses are resolved. Using data from 112 patrol officers in four Chicago police districts, we consider the impact of mental health services availability and CIT saturation (the percentage of district personnel that are CIT certified). Findings indicate that CIT training increased direction to mental health services primarily in districts with greater availability of mental health services. In districts with low service availability, higher CIT saturation increased direction to mental services. The opposite pattern emerged for contact only or informal call resolution. No effects were found for arrest as a call outcome.

The Crisis Intervention Team (CIT) program was first developed to reduce violence in encounters between the police and people with mental illness as well as provide improved access to mental health services. Although there is overwhelming popular support for this intervention, scant empirical evidence of its effectiveness is available—particularly whether the program can reduce the use of force. This investigation seeks to fill this gap in the literature by exploring the factors that influence use of force in encounters involving people with mental illness and evaluating whether CIT can reduce the likelihood of its use.

Police agencies across the country are struggling to respond to significant number of persons with serious mental illness, who are landing on their doorsteps with sometimes tragic consequences. Arguably, the most widely adopted approach, the Crisis Intervention Team (CIT) model, is a specialized police-based program designed to improve officers’ ability to safely and effectively respond to mental health crises. Conducting research on CIT is challenging; thus, the evidence base is limited. In this article, the author reviews the emerging literature, present a conceptual model of CIT effectiveness, and describe a study of CIT in Chicago. Findings from Chicago suggest that CIT is increasing linkage to services and reducing use of force in encounters with persons with mental illness. Lessons learned are discussed.

During the past four decades, fundamental changes in mental health and law enforcement policies have brought criminal justice professionals into increasing contact with people with serious mental illness (PSMI). This contact occurs at every stage of the criminal justice process. The police, who are the gatekeepers of the criminal justice system, interact frequently with PSMI. The current article introduces this special issue of the Journal of Police Crisis Negotiations, which is devoted to the study of the police and PSMI. Although many of the articles discuss the use of Crisis Intervention Teams, which are the most common law enforcement strategy for responding to calls that involve individuals in crisis, the volume addresses many other critical concerns that pertain to police interactions with special or vulnerable populations. Containing 17 original articles on the topic, this collection is one of the most comprehensive and varied of its kind to date.

The Crisis Intervention Team (CIT) model of collaboration between law enforcement and mental health is widely recognized as being “more than just training” for police officers; the core elements of CIT include a number of other components. However, several system- and policy-level obstacles can make successful implementation of CIT difficult in many communities. Three such challenges are addressed in this article: insufficient training and policies for dispatchers, poor availability of psychiatric emergency receiving facilities, and complexities related to implementation of CIT in rural settings. Collaboratively addressing these and other challenges will undoubtedly advance the goals of CIT.

Despite increased recent attention to improving the quality of encounters between police officers and people with serious mental illness, there are no measures available for assessing how consumers perceive their interactions with police officers. Drawing upon conceptual frameworks developed within social psychology, this study reports the development and testing of a new measure, the Police Contact Experience Scale (PCES), which yields indicators of procedural justice and coercion as evaluated by persons with mental illness in relation to specific encounters with the police. The PCES was administered to 154 individuals with mental illness that had police contact within the prior 12 months. Rasch rating scale analysis supported construct validity of a 10-item procedural justice and a 5-item coercion scale. Correlational analysis supported convergent validity for both scales. © 2010 Wiley Periodicals, Inc.

The Crisis intervention team model (CIT) is possibly the most well known and widely adopted model to improve police response to persons with mental illness. A primary goal of CIT programs is to divert individuals with mental illness from the criminal justice system to mental health services. In this paper we examine the effectiveness of fielding CIT trained and supported officers for influencing call outcomes using data from patrol officers (n = 112) in four Chicago Police districts. Results from regression analysis indicate that CIT certified officers directed a greater proportion of persons with mental illness to mental health services than their Non-CIT certified peers. CIT did not have an immediate effect on arrest. Moderator analysis indicates that CIT had its biggest effect on increasing direction to services and decreasing "contact only" among officers who have a positive view of mental health services and who know a person with mental illness in their personal life. Additional moderators of the CIT effect on call outcomes include level of resistance and the presence of a weapon. Findings from this study have important implications for policy, practice and future research.

The purpose of this study is to determine how the demographics of perceivers influence their stigma of people with mental illness or with substance abuse. A nationally representative sample (N = 968) was asked to respond to a vignette describing a person with a health condition (schizophrenia, drug dependence, or emphysema) and his/her family member. Consistent with our hypotheses, women were less likely to endorse stigma than men. Participants with higher education were also less likely to stigmatize than less educated participants. Contrary to our expectations, nonwhite research participants were more likely to endorse stigma than whites. Implications of these findings for better understanding the stigma of mental illness, and the development of anti-stigma programs, are reviewed.

A way to promote eliminating stigma surrounding mental illnesses is targeting the phenomenon in children. This study's purpose is to validate models of mental illness stigma on children in Grades 6–8. Children completed the revised Attribution Questionnaire in a pretest of a larger study on a mental health education program. Data from this study permitted testing of roles of demographics in these social cognitive models. Subsequent analyses using manifest model structural equations were mixed, but mostly showed adequate fit for multiple versions of the models. These results suggest that models of blame and dangerousness are relevant to the way 10 to 13-year-olds stigmatize mental illness. Demographics were not found to fit these models satisfactorily. Implications of these findings for stigma-change agenda are discussed.

Self–stigma is distinguished from perceived stigma (stereotype awareness) and presented as a three-level model: stereotype agreement, self–concurrence, and self–esteem decrement. The relationships between elements of this model and self–esteem, self–efficacy, and depression are examined in this study. In Study 1, 54 people with psychiatric disabilities completed a draft version of the Self–Stigma of Mental Illness Scale (SSMIS) to determine internal consistency and test–retest reliability of composite scales. In Study 2, 60 people with psychiatric disabilities completed the revised SSMIS plus instruments that represent self–esteem, self–efficacy, and depression. Stereotype awareness was found to not be significantly associated with the three levels of self–stigma. The remaining three levels were significantly intercorrelated. Self–concurrence and self–esteem decrement were significantly associated with measures of self–esteem and self–efficacy. These associations remained significant after partia...

The U.S. Surgeon General's report on mental health,(1999) and the report of President Bush s New Freedom Commission on Mental Health (2003) highlighted the public health impact of mental illness stigma. Using a medical model, several education programs have sought to diminish stigma's effect on public health by describing mental illness as a disease of the brain that can be treated successfully. This approach has been shown to be useful for reducing blame related to mental illness. Unfortunately, such public health messages may also exacerbate stigma by reinforcing notions of individual difference and defect. Alternatively, framing mental illness stigma as a social justice issue reminds us that people with mental illness are just that--people. The social justice perspective proposes that all people are fundamentally equal and share the right to respect and dignity. Applying this perspective to mental illness stigma allows us to increase our understanding of the problem and expands the means and targets of efforts to eliminate stigma. In this Commentary, we review the assertions of the public health perspective, highlighting some of the limitations that emerge from this approach. We then review stigma as social injustice and feature ways in which this paradigm advances understanding and changing stigma. THE PUBLIC HEALTH MODEL OF STIGMA AND STIGMA CHANGE Viewing stigma as a public health issue points to the ways in which stigma harms people with mental illness. Three are particularly notable: label avoidance, blocked life goals, and self stigma. Label Avoidance Epidemiological research suggests that more than half of the people who might benefit from mental health services opt not to pursue it (Narrow et al., 2000; Regier et al., 1993). One reason given is not wanting to suffer the stigma that accompanies being labeled "mentally ill" (Kessler et al., 2001). Blocked Life Goals People with mental illness frequently are unable to obtain good jobs or find suitable housing because of the prejudice of key members in their communities--employers and landlords (Farina, Thaw, Lovern, & Mangone, 1974; Link, 1987; Wahl, 1999). Self Stigma Some people with mental illness internalize stigma and experience significant decrements in self-esteem and self-efficacy as a result (Link & Phelan, 2001). Public Health Approach The public health approach to decreasing mental illness stigma largely relies on education programs dominated by the medical or disease model. Education is defined broadly in terms of any strategic format (that is, classrooms, public service announcements, magazine articles) that seeks to decrease stigma by informing the public about mental illness. One example is the National Alliance for the Mentally Ill's (NAMI) "Mental Illness is a Brain Disease" campaign, in which the organization distributed posters, buttons, and literature that provided information about the biological basis of serious mental illness. On a global scale, the World Psychiatric Association (WPA) is sponsoring its Open the Doors Global Program against stigma and discrimination focusing on schizophrenia. Now in its eighth year, the WPA information program educates the public about mental disease and corresponding treatment. There is some evidence that education may reduce the stigma of psychiatric illness. Several studies have shown participation in brief courses on mental illness and treatment lead to improved attitudes about people with mental illness (Corrigan et al., 2002; Wolff, Pathare, Craig, & Leff et al., 1996). However, research has also found that framing mental illness in biological terms may increase other negative attitudes about mental illness. One study found that disease explanations for mental illness reduced blame, but also provoked harsher behavior toward an individual with mental illness (Mehta & Farina, 1997). …