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Crisis Intervention Team (CIT) Training for First Responder

Op-Ed by Guy Beales, President of NAMI Massachusetts appears in the Fitchburg Sentinel & Enterprise November 13, 2011 Training aims to keep mentally ill out of jails

Op Ed – Training aims to keep mentally ill out of jails – Sentinel, 2011 Nov. 13 (PDF)

Katina Caraganis’s article, “First responders: More training needed for those handling calls involving mentally ill” (Sentinel, October 23), highlights a longstanding problem for first responders:  they frequently encounter highly volatile situations for which they feel inadequately prepared.

For many communities across the country, Crisis Intervention Team (CIT) training has made a substantial difference in preparing police officers to respond to mental health crisis situations.  At the recent state convention of the National Alliance on Mental Illness (NAMI) of Massachusetts at the Four Points Sheraton Hotel in Leominster, Major Sam Cochran (ret.) provided an overview of CIT.

Cochran is a leading advocate of the “Memphis Model” of pre-arrest jail diversion for those in a mental illness crisis.  CIT was developed in response to an incident in which police officers shot and killed a mentally ill individual.

CIT provides law enforcement-based crisis intervention training for helping individuals with mental illness.  In addition, CIT works in partnership with the mental health care system to provide services that are friendly to the individuals with mental illness, family members, and the police officers.

As a result, additional training on how to respond to someone with mental illness reduces the risk of injuries to officers, avoids unnecessary arrests, directs individuals with mental illnesses to appropriate treatment, increases public safety, and lowers costs to taxpayers.

This last point merits further examination.  As Worcester County Sheriff Lew Evangelidis stated, about 25 percent of the inmates at the Worcester House of Correction are taking psychiatric medications and the prison spends $5 million on inmate medical expenses.  According to a recent study by the Treatment Advocacy Center (TAC), “there are now more than three times more seriously mentally ill persons in jails and prisons than in hospitals.”  In other words, “America’s jails and prisons have become our new mental hospitals.”

This situation results in enormous costs since offenders with mental illnesses are “frequent flyers” – that is, they experience high rates of recidivism – and their imprisonment costs more than prisoners without mental illnesses.

In addition, the TAC report notes, mentally ill inmates stay longer in jail; are more likely to commit suicide; may be subject to abuse; and, because of sometimes impaired judgment, may be disruptive and/or destructive.

The costs of incarceration, financial and human, are high.  So, too, are costs resulting from injuries to officers: medical expenses, leave for recuperation, and replacement until an officer returns to duty.  To these, one might add the cost of court appearances and reports following an arrest.

Article: Crisis Intervention Focus of Discussion http://www.sentinelandenterprise.com/local/ci_19125753

Article: First responders: More training needed for those handling calls involving mentally ill http://www.sentinelandenterprise.com/ci_19176634?source=most_viewed

Letter to the Editor

Letter to the Editor of The Boston Globe and the Somerville Journal

Carol Lynn Kingsley’s death on July 23 is a tragedy for all of us.  The National Alliance on Mental Illness (NAMI) of Massachusetts calls for a review of both Cambridge Hospital’s and the Somerville Police Department’s protocols and procedures for handling psychiatric emergencies and to institute any reforms that such reviews might warrant.  More widely, we hope that health and public safety officials throughout the Commonwealth will take this opportunity to assess the readiness of their organizations to respond to emergencies so as to avoid injury or death of persons with mental illnesses and public safety officers.

Ms. Kingsley, who was well known to Cambridge Hospital, was transported to the hospital for a mental health evaluation early in the morning of July 23.  She was released, and within hours three police officers were called to her home to answer a domestic disturbance call.  She allegedly grabbed a knife, barricaded herself in a bathroom, and wounded the officers before being shot dead.

In the aftermath of these events, we call upon the Departments of Public Health and Mental Health to conduct a full investigation into the actions of Cambridge Hospital and to make public the results of its findings, including any internal investigation by the hospital.  We would expect that any findings and recommendations regarding psychiatric evaluation procedures and protocols be shared with all general hospital emergency rooms in the Commonwealth.  We implore all hospitals to take the steps necessary to ensure that their emergency room staff is adequately trained with regard to conducting psychiatric assessments and evaluations.

Local police departments are our valued public safety officers, the first responders to every possible human affliction or conflict.  They must have the tools and resources in order to respond to every situation safely and humanely.  We also call upon the Somerville Police Department to review its protocols and procedures in light of this tragedy and to determine if training of its officers in mental health crises is warranted.

NAMI has endorsed the Crisis Intervention Team (CIT) program originally developed by the Police Department of Memphis, Tennessee, in partnership with mental health consumers, family members and mental health professionals.  The goal of this nationally recognized program is to set a standard of excellence for the police with respect to treatment of individuals with mental illness, thereby effectively managing crises, decreasing the use of force by officers and increasing mental health consumer access to community services.  The key is collaboration.  Although pilot police and mental health provider collaborations have occurred in a few Massachusetts municipalities (for example in Berkshire County), they are the exception rather than the expectation.  CIT must be expanded across all municipalities.

The CIT model will serve all of us well – as consumers, family members, neighbors, public safety officers, emergency room personnel, and taxpayers.  As Major Sam Cochran of the Memphis Police Department eloquently states, “Crises are about people, about our community, our families, our friends, and our loved ones.”  Among the many benefits realized by the Memphis CIT program are “positive perceptions among police officers; providing very efficient crisis response times; increasing jail diversion among those with mental illness; improving the likelihood of treatment continuity with community based providers; and impacting psychiatric symptomatology for those suffering from a serious mental illness as well as substance abuse disorder.  This was all accomplished while significantly decreasing police officer injury rates.”  Indeed, after the introduction of CIT in Memphis, the injury rate among officers responding to “mental disturbance calls” dropped by 80%.  In Albuquerque, SWAT team involvement in response to crisis intervention calls declined by 58%.

Massachusetts would do well to adopt the Memphis CIT model.  Indeed, we have the opportunity to join those few states which are implementing CIT training on a statewide basis.

We do not know much of what happened on the morning of July 23rd.  We do know that Carol Lynn Kingsley is dead; that the many unanswered questions deserve a full and transparent investigation; and that all of us will benefit when our police officers throughout the Commonwealth have the best possible training to respond to mental illness emergencies.

Guy Beales is President of NAMI Massachusetts.

Articles in the Somerville Journal covering the events: