Law Enforcement Law Enforcement Responses to Responses to

People with Mental People with Mental Illnesses:Illnesses:

Improving OutcomesImproving OutcomesBrought to you by the National Council Brought to you by the National Council and the Council of State Governments and the Council of State Governments Justice Center, with support from the Justice Center, with support from the

Bureau of Justice Assistance, U.S. Bureau of Justice Assistance, U.S. Department of JusticeDepartment of Justice

© CSG Justice Center, New York, NY© CSG Justice Center, New York, NY

The Challenge for Law The Challenge for Law EnforcementEnforcement

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What Is the Problem?What Is the Problem?

People with mental illnesses, People with mental illnesses, substance use disorders, and co-substance use disorders, and co-

occurring disorders are significantly occurring disorders are significantly overrepresented in the criminal overrepresented in the criminal

justice system.justice system.

Criminal Justice Criminal Justice Populations Are Populations Are

SkyrocketingSkyrocketing

Source: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Correctional Surveys (The Annual Probation Survey, National Prisoner Statistics, Survey of Jails, and The Annual Parole Survey) as presented at http://www.ojp.usdoj.gov/bjs/glance/corr2.htm.

Source: Pew Charitable Trusts’ Public Safety Performance Project (2008). “One in 100: Behind Bars in America 2008.” Available at http://www.pewcenteronthestates.org/report_detail.aspx?id=35904.

Scope of the ProblemScope of the Problem Over 14 million arrests each year, Over 14 million arrests each year,

involving more than 9 million adults.involving more than 9 million adults. Over 1 million arrestees have serious Over 1 million arrestees have serious

mental illnesses.mental illnesses. 75% of those with serious mental 75% of those with serious mental

illnesses have co-occurring substance illnesses have co-occurring substance use disorders.use disorders.

The vast majority will be released to The vast majority will be released to the community.the community.

Specialized Law Specialized Law Enforcement-Based Enforcement-Based Response InitiativesResponse Initiatives

Enhance traditional law enforcement roles to Enhance traditional law enforcement roles to provide a new set of response options for provide a new set of response options for frontline personnel tailored to the needs of frontline personnel tailored to the needs of people with mental illnessespeople with mental illnesses

When appropriate, establish a link for these When appropriate, establish a link for these individuals to services in the communityindividuals to services in the community

Ensure law enforcement-based agencies have Ensure law enforcement-based agencies have strong collaborative ties to mental health strong collaborative ties to mental health partners, other criminal justice agencies, and partners, other criminal justice agencies, and community providerscommunity providers

Law Enforcement Law Enforcement ResponsesResponses

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Law Enforcement Law Enforcement InvolvementInvolvement Call loadCall load

Over the course of a six-year period (from 1998 to 2004), the Akron [OH] Police Department responded to 10,004 calls related to a “mental disturbance.” This represents 6.55% of the total call load (1,527,281 calls) during that period (Teller et al., 2006).

Temporary solutionsTemporary solutions Dispositions typically available to officers include informal

resolution at the scene (occurring the majority of the time), transport to a mental health facility for evaluation, or arrest (Teplin 2000; Lamb 2002).

ArrestArrest Officers generally arrest people exhibiting signs of mental Officers generally arrest people exhibiting signs of mental

disturbance because they fit into a “gray area”—not sick enough disturbance because they fit into a “gray area”—not sick enough for admission to the mental facility but too disruptive to be for admission to the mental facility but too disruptive to be ignored. The arrest rate of people with mental illnesses in this ignored. The arrest rate of people with mental illnesses in this study was almost 16.5%, significantly higher than that for non-study was almost 16.5%, significantly higher than that for non-mentally ill suspects (Teplin 1984).mentally ill suspects (Teplin 1984).

Law Enforcement Law Enforcement ConcernsConcerns

Law enforcement officers lack

information and skills to de-escalate crises, andinformation and skills to de-escalate crises, and reliable and efficient access to mental health reliable and efficient access to mental health

services.services.

These calls for service are complex, time-These calls for service are complex, time-consuming, and potentially volatile.consuming, and potentially volatile.

The largest psychiatric inpatient facilities in the The largest psychiatric inpatient facilities in the United States today are actually jails –Rikers United States today are actually jails –Rikers Island in New York City and the Los Angeles Island in New York City and the Los Angeles County Jail.County Jail.

What Are Specialized What Are Specialized Law Enforcement Law Enforcement

Responses?Responses?Programs that are Programs that are law enforcement-law enforcement-basedbased include include

Crisis intervention teams: Crisis intervention teams: A self-A self-selected cadre of officers trained to selected cadre of officers trained to identify signs and symptoms of mental identify signs and symptoms of mental illness, de-escalate the situation, and bring illness, de-escalate the situation, and bring the person in crisis to an efficient, round-the person in crisis to an efficient, round-the-clock treatment center. the-clock treatment center.

Co-responder teams: Co-responder teams: A specially-trained A specially-trained officer paired with a mental health officer paired with a mental health professional to respond to the scene of a professional to respond to the scene of a crisis involving mental illness.crisis involving mental illness.

OutcomesOutcomes

Reduced officer injuriesReduced officer injuries CIT officer injury rates in Memphis (TN) CIT officer injury rates in Memphis (TN)

decreased from one in every 28,571 events in decreased from one in every 28,571 events in the three-year period prior to implementing the three-year period prior to implementing CIT, to one in every 142,857 events in the CIT, to one in every 142,857 events in the years following implementation (Dupont & years following implementation (Dupont & Cochran, 2000).Cochran, 2000).

The San Jose (CA) Police Department’s CIT The San Jose (CA) Police Department’s CIT program reported a 32% decrease in officer program reported a 32% decrease in officer injuries over a one-year period following injuries over a one-year period following program implementation (Reuland, 2004).program implementation (Reuland, 2004).

OutcomesOutcomes

Reduced SWAT call-outsReduced SWAT call-outs The rate of TACT (similar to SWAT) calls in The rate of TACT (similar to SWAT) calls in

Memphis has decreased by nearly 50% since Memphis has decreased by nearly 50% since the implementation of CIT (Dupont & Cochran, the implementation of CIT (Dupont & Cochran, 2000).2000).

Since the implementation of CIT in Since the implementation of CIT in Albuquerque (NM), the use of SWAT teams Albuquerque (NM), the use of SWAT teams involving a mental health crisis intervention involving a mental health crisis intervention has decreased 58% (Bower & Pettit, 2001).has decreased 58% (Bower & Pettit, 2001).

OutcomesOutcomes Reduced arrest ratesReduced arrest rates

Law enforcement-based programs made arrests in Law enforcement-based programs made arrests in only 2% - 5% of calls involving a person with mental only 2% - 5% of calls involving a person with mental illness, as compared with a 13% arrest rate in the illness, as compared with a 13% arrest rate in the mental health-based approach (Steadman et al., mental health-based approach (Steadman et al., 2000).2000).

Individuals with mental illnesses who are diverted Individuals with mental illnesses who are diverted from jail spent more time in the community without from jail spent more time in the community without a concomitant increase in arrest (Steadman & a concomitant increase in arrest (Steadman & Naples, 2005).Naples, 2005).

An analysis of Houston’s (TX) 1,439 CIT calls An analysis of Houston’s (TX) 1,439 CIT calls revealed that only 17 people with mental illnesses revealed that only 17 people with mental illnesses had been arrested (Reuland, 2004).had been arrested (Reuland, 2004).

OutcomesOutcomes Increased access to mental health Increased access to mental health

servicesservices People diverted from jail had significantly greater access People diverted from jail had significantly greater access

to crisis services (emergency room and hospitalization) to crisis services (emergency room and hospitalization) and non-crisis services (medication and counseling) than and non-crisis services (medication and counseling) than people who were not diverted from jail (Steadman & people who were not diverted from jail (Steadman & Naples, 2005).Naples, 2005).

CIT-trained officers in Akron transported people with CIT-trained officers in Akron transported people with mental illnesses to psychiatric emergency services mental illnesses to psychiatric emergency services significantly more often than their non-CIT-trained significantly more often than their non-CIT-trained counterparts. This study showed no difference between counterparts. This study showed no difference between the two groups in numbers of arrests (Teller et al., the two groups in numbers of arrests (Teller et al., 2006).2006).

In Memphis’ CIT program, the referral rate from law In Memphis’ CIT program, the referral rate from law enforcement to the emergency service increased by 42% enforcement to the emergency service increased by 42% in its first four years (Dupont & Cochran, 2000).in its first four years (Dupont & Cochran, 2000).

How Do the How Do the Essential Essential ElementsElements Help? Help?

The 10 elements were derived The 10 elements were derived from recommendations made from recommendations made by a broad range of by a broad range of practitioners and other practitioners and other subject matter experts.subject matter experts.

They provide a common They provide a common framework for program framework for program design and implementation to design and implementation to promote positive outcomes.promote positive outcomes.

They are sensitive to the They are sensitive to the distinct needs and resources distinct needs and resources of a particular jurisdiction.of a particular jurisdiction.

As such, they reflect a As such, they reflect a process-orientedprocess-oriented approach approach rather than a rather than a model model replicationreplication approach. approach.

What Are the 10 Essential What Are the 10 Essential Elements of a Law Elements of a Law

Enforcement-Based Response?Enforcement-Based Response?1.1. Collaborative Planning and Collaborative Planning and

ImplementationImplementation

2.2. Program DesignProgram Design

3.3. Specialized TrainingSpecialized Training

4.4. Call-Taker and Dispatcher ProtocolsCall-Taker and Dispatcher Protocols

5.5. Stabilization, Observation, and Stabilization, Observation, and DispositionDisposition

What Are the 10 Essential What Are the 10 Essential Elements of a Law Elements of a Law

Enforcement-Based Response?Enforcement-Based Response?6.6. Transportation and Custodial TransferTransportation and Custodial Transfer

7.7. Information Exchange and Information Exchange and Confidentiality Confidentiality

8.8. Treatment, Supports, and ServicesTreatment, Supports, and Services

9.9. Organizational SupportOrganizational Support

10.10. Program Evaluation and SustainabilityProgram Evaluation and Sustainability

A View from the StreetA View from the Street

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In 2007, the Los Angeles Police Department

received71,469 calls

for service that involved mental illness.

SMART – Co-response Model

Implemented in 1993 after 1991 Los Angeles County Board of Supervisors’ Task Force found societal failure to adequately meet the needs of the mentally ill population.

Goal is to provide intervention, referral, or placement for an individual with mental illness, allowing officers to quickly return to the field.

CAMPCAMP

Case Assessment Case Assessment Management Management

ProgramProgram

CAMP – The Beginning

A 2004 database review revealed that 67 individuals

with mental illnesses accounted for 536 calls for service

during an eight-month period.

Management Question

If I could tell you when a crime will occur, where a crime will occur, and who the suspect will be,will you allow me to deploy police

resources to prevent the crime?

CAMP Philosophy/Goal

Break the cycle of 911 and ER abuse multiple emergency service contacts

(police, fire, paramedics) high use of the County’s Department

of Mental Health (DMH) psychiatric emergency services

How It Happens Does not identify and track individuals

based solely on mental illness. Provides linkage and follow-up to

appropriate services. Involves discussions with all stakeholders:

Prosecutors Public defenders Probation Department of Mental Health Family

How It Happens

Los Angeles County Department of Mental Health clinician directs and focuses contact.

Los Angeles Police Department provides support and infrastructure of any mental health investigation.

Patient Privacy

Separate databases Need to know and right to know

CAMP Criteria

Repeated contacts with emergency responders (police, fire, paramedics)

Focus of barricaded suspect scenario

Attempted Suicide by Cop (SbC) Repeated contacts with DMH

emergency services

SWAT & Mental Illness

37% of SWAT calls resulted in mental health holds with no criminal charges filed.

Another 33% of SWAT calls involved a mental illness component.

School Violence

Between April 2007 and March 2008, CAMP has handled 35 campus violence calls. These calls involved subjects who

expressed ideations of homicide on a campus;

expressed ideations of suicide on a campus; or

expressed ideations of mass murder on a campus.

Success Stories

Between April 2007 and March 2008, CAMP has resulted in:

22 conservatorships 16 court-ordered treatments Four subjects reunited with family

members in other states Continuous mental health linkage

Over 100 active cases

For More InformationFor More Information

To download Improving Responses to People with Mental Illnesses, go to http://consensusproject.org/downloads/le-essentialelements.pdf.

Print copies may also be ordered from the National Criminal Justice Reference Service at http://www.ncjrs.gov/App/Publications/abstract.aspx?ID=245259.

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