The CIT: A Revolutionary Tool for Assisting Those Suffering from Mental Crisis
Author: James D. Estep


Crisis intervention, and individuals with a mental illness: An introduction

An unfortunate fact of life is that a crisis can occur at any time and to anyone… it has no respect of persons. McMains & Mullins (2014) define a crisis as “a situation that exceeds a person’s ability to cope”. This definition shows that a crisis can take many forms (financial, etc.). A crisis is a dynamic concept in that it is fluid in nature and has no one set pattern or framework in its occurrence. A crisis intervention is defined by Lanceley (2003) as “an assortment of techniques intended to return an individual in crisis to their normal functioning level and to get them past potentially dangerous impulses”. The need for crisis intervention involving those having a mental illness is a result of the Deinstitutionalization Movement which occurred in the 1970s. Ellis (2011) states that during the 1970s, individuals with a mental illness were de-institutionalized (removed) from the psychiatric hospitals wherein they resided. He reveals that the goal of this movement was for the allowance of those suffering from chronic mental illnesses to become reintegrated into society, destigmatized, and to receive mental health services on an individual basis. These services would be applied by the usage of what is known as the “3R Conceptual Model of Care”, and which was comprised of the concepts of response, relapse, and recovery.

The de-institutionalization of individuals with a mental illness was plagued by various challenges; Ellis discusses some of these challenges, and which includes the fact that many of the patients that were released had become “institutionalized” (accustomed to their controlled environment) and therefore, had difficulty in reintegrating back into the community. Other challenges mentioned is that of these individuals having little or no social skills, support, or resources to assist them. Tucker, Van Hasselt, Vecchi, and Browning (2011) are in agreement with Teplin (2000) in revealing other challenges which pertains to the de-institutionalization movement, and which includes the restriction of federal funding for mental health as well as the introduction of legal reforms which gave persons with a mental illness the right to live in the community without receiving treatment. As a result of this, these individuals came into contact with law enforcement officials more and more.

 In contemporary society, many innovative criminal justice programs have been developed for diverting some individuals having a mental illness from being incarcerated and allowing for the assistance of these selfsame individuals through the utilization of diversionary programs (i.e. mental health courts). One such approach/special response which has been developed and which is used by law enforcement and mental health officials for the purpose of intervening/assisting those in mental crisis is the “Crisis Intervention Team” (CIT).

A review of the literature shows that the utilization of a CIT has been effective in its goal of assisting those in mental crisis and has expanded all across the U.S. since its inception in Memphis. Morrissey, Fagan, and Cocozza (2009) state that more than 300 municipal or county police departments across the U.S. have utilized their own CIT and McMains & Mullins support this by stating that the CIT has been endorsed by more than 30 states, therefore, illustrating the need for this type of crisis intervention.

CIT: An introduction and overview

A Crisis Intervention Team (CIT) is defined by Browning, Van Hasselt, Tucker, and Vecchi (2011) as “a type police-based specialized response, which involves collaboration between mental health and law enforcement involving specialized training for law enforcement officers in mental health issues, crisis intervention/de-escalation, and service user-friendly mental health resources”.

It has been well documented that the CIT was born out of a tragedy (Watson & Fulambarker, 2012). The CIT was created in 1988 in Memphis, Tennessee and Browning, et al. (2011) recalls the event as told by Vickers (2000) in that it involved the Memphis Police Department’s responding to a call involving an individual who had been diagnosed with schizophrenia and who also was known to have suicidal tendencies. The subject was known to many officers but those responding to this particular incident were new and unfamiliar with the individual. The subject became agitated when confronted by the officers as well as by their demanding that he drop a knife in his possession. During the course of the altercation, the subject made sudden movements, which resulted in his being fatally shot by the officers. As a result of this tragic event, a collaborative effort was born and which would bring about the creation of the CIT. Steadman, Deane, Borum, and Morrissey (2000) makes mention of this collaborative framework, and which included the Memphis Police Department, the local chapter of the National Alliance on Mental Illness (NAMI), and the Universities of Memphis and Tennessee in developing a specialized response team within the police department for the purpose of assisting those in a mental crisis. Dupont, Cochran, and Pillsbury (2006) defines NAMI as “a nonprofit, grassroots advocacy organization whose mission is the elimination of mental illnesses and to improve the quality of life for those who are affected”. One of the most renowned results of this collaborative framework was the creation of a single location mental healthcare facility known as “The Med”. Browning, et al. (2011) describes this facility as having a no-refusal policy for police referrals and a speedy intake process which allows police officers to admit persons with a mental illness and to resume their patrol duties in approximately 30 minutes time.

The makeup of a CIT is comprised of three core elements: the law enforcement, the mental health, and advocacy communities. Dupont, et al. (2007) go into great detail in describing these three components in their article “Crisis Intervention Team Core Elements”, which bears further reading in order to gain a greater understanding of each component and its role in the CIT. The purpose and goals of CIT are revealed by Dupont et al. (2007) as being twofold… the improvement of officer and consumer safety and to redirect individuals with a mental illness from the judicial system to the mental health care system.

The training required for CIT members entails a 40 hour course which consists of classroom didactics, experiential role-play scenarios, field visits to local mental health facilities, and the participation in a ride along program (Ellis, 2011). The training course is very comprehensive and includes lectures which covers many topics, some of which include the policies and procedures of CITs, community resources which are available to CIT members for assisting those in a mental crisis, the recognition and understanding of the signs and symptoms of mental illnesses, alcohol and drug assessment, crisis intervention, and de-escalation skills. For a more comprehensive list of the curriculum involved in CIT training, the reader should refer to the article by Dupont et al (2007). The goal of CIT training, as stated by Ellis, is to train law enforcement personnel in redirecting individuals suffering from a mental illness and whom have engaged in noncriminal activities to the appropriate treatment services instead of the criminal justice system.

CIT and Crisis Negotiations Teams (CNT)

Crisis negotiations has not always been at the forefront of law enforcement. McMains & Mullins point out that prior to 1973, there was no training in crisis management, hostage negotiations, or abnormal behavior in police departments. O’Neill (2012) supports this fact by pointing out that the use of negotiations by law enforcement dates to the tragedy which occurred at the 1972 Olympic Games in Munich, Germany. McMains & Mullins discusses the “second generation” of negotiations in the 1980s as having evolved from prisoners and terrorists to situations involving emotionally disturbed individuals, trapped criminals, and domestic incidents. They also reveal that in the 2000s, negotiations evolved even further due to crisis situations having taken on a greater emphasis being placed upon them by the media and general public.

The individuals who must attempt to quell the aforementioned situational types, as well as those involving hostages in a peaceful manner, are those who belong to a “Crisis Negotiations Team” (CNT). The evolution involving both the CIT and CNT is that of their cross-training/ blending with one another in order to bring about a peaceful resolution to critical incidents, including those involving individuals having a mental illness. Hostage situations requiring negotiations is a regularity in the existence of a CNT. Miller (2007) states that “hostage negotiations is all about psychology”, herein is the parallelism of the CIT and CNT. The cross-training between these two entities is beneficial to both and is a common practice in contemporary society. Noesner (1999) points out that many law enforcement agencies continue to utilize a linear approach to crisis resolution rather than a synchronized approach (i.e. the relationship/collaboration between the CIT and CNT.

A cross-training with or having a CIT officer(s) as a member of a crisis negotiations team is beneficial for both the CIT and CNT. The duties of a CIT officer acting as a member of a crisis negotiations team are varied but critical. Lanceley points out that while a mental health professional such as a CIT officer does not negotiate, they do provide an assessment of the mental state of the subject/offender, make recommendations for negotiation techniques and approaches for the CNT, and can render emotional and stress management support to the team. Kitaeff (2011) provides other areas of training that a mental health professional/ consultant such as a CIT officer should possess which will allow them to better operate with a CNT. He states that said individual(s) should attend a basic negotiator school and should also be familiar with the literature of hostage/ crisis negotiations, critical incident response, SWAT operations, and high-risk operations. On the other hand, CNT members should receive and/ or possess training in areas related to that of the CIT. It would behoove CNT members to possess a working knowledge of the various mental illnesses (and their signs and symptoms) which may be encountered in the field.  CNT members should also be trained in various aspects of the behavioral sciences such as the interpretation of body language and the recognition of verbal cues that may arise from a subject/ offender.

Another area in which CITs and CNTs cross-train is in that of the utilization of the FBI’s “Behavioral Influence Stairway Model” (BISM). The BISM is described by Vecchi (2009) as a process for developing a relationship between a communicator (i.e. hostage negotiator, CIT member) and an individual in crisis which results in influencing said individual to accept and act upon the suggestions made by the communicator. The BISM is comprised of four stages and Vecchi describes each stage in great detail. The stages of the BISM are as follows:

  1. Active listening: This stage is the foundation of BISM. It allows the communicator to initiate/encourage conversation with the individual in crisis, and which is done through the usage of various active listening skills (ALS) such as paraphrasing, mirroring, and summarizing their understanding of the individual’s plight in their own words.
  2. Empathy: This stage alludes to an identification with and understanding of the individual’s situation, feelings, and motives. Vecchi points out that empathy should not be confused with sympathy which involves pity for the individual, but rather allows the communicator to understand and then to be understood by the individual in crisis.
  3. Rapport: Once empathy has been affirmed from the viewpoint of the person in crisis, a rapport can develop between the individual and the communicator and which is based upon trust and mutual affinity.
  4. Influence: The final stage of the BISM is brought about by the communicator’s having “earned the right” to make suggestions to the person in crisis which pertains to identifying solutions and alternative means for resolving the situation.

Vecchi states that the BISM has been honed over the past 30 years and that it has been shown to be highly effective in resolving crisis without injury and within relatively short periods of time. There are other ways by which those in either a CIT or CNT (or both) have or currently use for cross-training in order to better meet their goals. One such method is described by McMains & Mullins, and it is that of competitions amongst hostage/ crisis negotiations teams. They deem this type of training as “external training”. This competition has been held annually in San Marcos, Texas since 1990. Since mental health professionals such as CIT officers are frequently a member of a CNT, this type training is beneficial to both in the “cross-breeding” of their skillsets.

Lastly, one other training method provided for by McMains & Mullins is that of the use of roleplay training, which they deem as “internal training” in that it can be conducted within a team such as a CIT/ CNT and does not require members to travel to compete as in the previously mentioned competition training. McMains & Mullins state that roleplay training is one of the most widely used and valuable forms of training. In this type training, participants are exposed to replicated scenarios/ situations which they may face in the field (i.e. hostage-takers, mentally ill and/ or suicidal individuals). This type of training educates participants on how to de-escalate potentially volatile situations and it also allows them to gauge their performance and to ascertain areas requiring improvement. This type of training exercise is widely used by CITs as well as by the previously discussed CCRT. The value of this type of training methodology is in its ability to better educate and prepare participants on possible real world situations from a practical standpoint.

The cross-training/ intermingling between CITs and CNTs has shown positive results. McMains & Mullins illustrate this by providing the example of the Weber County Utah Sheriff’s Department, which has appointed a lieutenant to command both the department’s negotiations team as well as its CIT program.

Conclusion and summary

The history of crisis intervention has evolved throughout the years, allowing for persons in mental crisis to receive much needed assistance. The crisis intervention team (CIT) was created as a result of a tragic event. It was through a collaborative effort made by various agencies and organizations that has made this method of crisis intervention possible. The CIT has proven to be successful in its goal of assisting these individuals and has been emulated by law enforcement agencies nationwide. The CIT has been successful and has evolved beyond that of its original scope in that it now cross-trains with Crisis Negotiations Teams (CNT), and oftentimes, a CIT officer is a part of a CNT also. The cross-training involved between these two interventional entities consists of areas in the behavioral sciences such as the Behavioral Influence Stairway Model (BISM), which can assist in the de-escalation of potentially volatile situations. Other cross-training methods such as team competitions and the use of roleplay scenarios has been shown to be productive in assisting with those suffering from some form of crisis.


References

Browning, S. L., Van Hasselt, V.B., Tucker, A. S., & Vecchi, G. M. (2011). Dealing with individuals who have mental illness: The crisis intervention team (CIT) in law enforcement. The British Journal of Forensic Practice, 13(4), 235-243.

Dupont, R., Cochran, S., & Pillsbury, S. (2007). Crisis intervention team core elements. Unpublished report, University of Memphis.

Ellis, Horace A, RN, MSN, A.R.N.P., P.M.H.N.P.-B.C. (2011). The crisis intervention team--A revolutionary tool for law enforcement: The psychiatric-mental health nursing perspective. Journal of Psychosocial Nursing & Mental Health Services, 49(11), 37-43.

Kitaeff, J. (2011). Handbook of police psychology. New York, NY: Taylor & Francis Group.

Lanceley, F. J. (2003). On-scene guide for crisis negotiations (2nd Ed.). Boca Raton, FL: CRC Press.

McMains, M. J., & Mullins, W. C. (2014). Crisis negotiations: Managing critical incidents and hostage situations in law enforcement and corrections (5th Ed.). Waltham, MA: Anderson Publishing.

Miller, L. (2007, May 22). Hostage negotiations: Psychological strategies for resolving crises. Retrieved from https://www.policeone.com/standoff/articles/1247470-Hostage-negotiations-Psychological-strategies-for-resolving-crises/

Morrissey, J. P., Fagan, J. A., & Cocozza, J. J. (2009). New models of collaboration between criminal justice and mental health systems. The American Journal of Psychiatry, 166(11), 1211-1214.

Noesner, G. W. (1999, January). Negotiation concepts for commanders. Retrieved from http://www.au.af.mil/au/awc/awcgate/fbi/negot_cmdrs.pdf

O’Neill, K. (2012, November 5). Crisis negotiation team. Retrieved from http://www.corrections.com/news/article/31685-crisis-negotiation-team.

Steadman, H. J., Deane, M. W., Borum, R., & Morrissey, J. P. (2000). Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services (2014).

Teplin, L.A. (2000). Keeping the peace: Police discretion and mentally ill persons. National Institute of Justice Journal 244: 8-15.

Tucker, A. S., Van Hasselt, V. B., Vecchi, G. M., & Browning, S. L. (2011, October). Responding to persons with mental illness. Retrieved from https://leb.fbi.gov/2011/october/responding-to-persons-with-mental-illness

Vecchi, G. M. (2009). Conflict and crisis communication: The behavioral influence stairway model and suicide intervention. Annals of the American Psychotherapy Association, 12(2), 32-39.

Vickers, B. (2000). Memphis Tennessee, Police Department’s Crisis Intervention Team. U.S. Bureau of Justice Statistics: Bulletin from the field, Practitioner perspectives. Retrieved from http:// www.ncjrs.gov/ pdffiles1/bja/ 182501.pdf.

Watson, A. C., & Fulambarker, A. J. (2012). The crisis intervention team model of police response to mental health crises: a primer for mental health practitioners. Best Practices in Mental Health, 8(2), 71.



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