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Police confrontations with mentally ill subjects can quickly turn tragic, as neither side may understand the other. Specially trained crisis intervention teams have spread around the country to prevent deaths, injuries, and unneccessary incarceration.

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Laura Usher, Crisis Intervention Team Program Manager, National Alliance on Mental Illness (NAMI)

Mary Neal, Director and co-founder, Assistance to the Incarcerated Mentally Ill

Dr. Randolph DuPont, clinical psychologist and Prof. of Criminal Justice, University of Memphis

Sam Cochran, Major, Memphis Police Dept. (retired) and Project Coordinator, University of Memphis CIT Center

Links for more information:

16-40 Crisis Intervention Teams

Reed Pence: When people need help in the worst way, they often look to their local police department. We may call on them after our home has been robbed… Or when we need to get our keys out of a locked car. It’s reassuring to know that a police officer is only a phone call away and ready to tackle the job. However, when that phone call involves a mentally ill person in severe distress, having a mental health crisis, things can quickly take a turn for the worse. Emotion, miscommunication, and fear on both sides can combine to create a situation that’s unsafe for everyone involved.

Laura Usher: One of the things that, you know, we found through 25 years of working with law enforcement agencies is that people with mental illness often respond very differently to police commands and police presence than your average citizen. People can get very frightened and that can actually escalate their behavior or their emotions. So making someone who maybe wasn’t being violent but was just very upset to get scared and then lash out at the officer or to hurt themselves.

Pence: That’s Laura Usher, Crisis Intervention Team Program Manager at the National Alliance on Mental Illness, or NAMI. She says police officers deal with mental health crises more frequently than most people think.

Usher: Calling involving people with mental illness in crisis are surprisingly common, something like 10 to 12 percent of calls for service to law enforcement involve a mental health issue. And most of these calls will resolve in a peaceful and uncomplicated way, but a few of them sort of spiral out of control into violent encounters.

Pence: When that happens… Usher says unfortunately, it’ s often exactly what a mentally ill subject wants.

Usher: A lot of these calls are related to suicide attempts. Either the individual is attempting suicide or thinking about suicide or hoping to provoke an officer to shoot, a phenomenon we call “suicide by cop.” And then other calls involve a person with mental illness who is having hallucinations or delusions or it’s just their behavior is unusual to the people around them or concerning to the people around them. A lot of these calls actually originate from the family of the person in crisis. They know their loved one well and they know that the person is in crisis and they don’t really have a lot of options for places to call for help, so they wind up calling the police.

Pence: Mental illness comes in a variety of forms. Disorders such as schizophrenia, bipolar disorder, and posttraumatic stress disorder all look different. Mary Neal, director and founder of the group “Assistance to the Incarcerated Mentally Ill” says that can make it difficult for a police officer to properly evaluate the situation and choose what action to take.

Mary Neal: A lot of times we see films of mentally ill people being harmed by police officers on YouTube and other social networks, and we may say, “Well, why didn’t he stop when the police told him to stop?” The thing is that when you and I hear a police officer say, “Halt!” we recognize this as being the voice of authority. If a person is in the middle of a mental health crisis, which is most often the case when the police are called, they may hallucinate and they may see that police officer who is approaching them and saying, “Halt!” – they may not even see that person as a police officer. Because hallucinations to people with advanced mental illness are as real as what you and I see and we know to be real.

Pence: Crisis intervention teams, or C-I-T, were developed to help police deal with exactly those kind of situations, the first such program was started in Memphis in 1987 after police shot and killed a mentally ill subject brandishing a knife. The man had been ordered to drop his weapon but became more agitated instead. CIT aims to educate police officers about mental illnesses and provide ways to address them without escalating a situation into a violent conflict. Randolph DuPont is a clinical psychologist and professor of criminal justice at the University of Memphis who has been working on CIT training since its inception. He says the program gives officers the tools required to effectively serve the needs of the mentally ill… and still keep the public safe.

Randolph DuPont: The main thing you hear, first of all, is that the officers approach the scene in a strategic way — that is, they consult with each other, they develop a strategy. The second thing is they’re more likely to gather additional information that is going to help them in the intervention, and what we hear consistently from those that have mental illness is that the officers are much more likely also to be serious with them because even though a person that’s going through a crisis often is still able to communicate and sometimes the crisis might have some very reasonable thing that formed the basis of that crisis and the officers can address those things in a way that people don’t always expect is possible.

Pence: Ideally, Usher says, a police force will have at least one CIT trained officer on each shift. For some departments that may mean that all officers are trained, while for larger departments, only a fraction will require training and be called to the scene as needed. CIT training itself is a mixture of mental illness awareness and scenario-based simulation where officers learn how to recognize mental health symptoms. Training also helps to foster relationships between police officers and people who have a mental illness.

Usher: The bulk of the time, though, is spent in sort of practical application so the officers spend a lot of time interacting with people’s mental illness who are not in a crisis situation. They sit down with them and talk about boyfriends, girlfriends, hobbies, jobs — just ordinary everyday things to kind of demystify the person living with the mental illness and also to help build a little bit of a relationship so that a person’s mental illness who was maybe part of this group isn’t scared to call the police, and so the police aren’t scared of the person with mental illness. And then there’s also a lot of time dedicated to scenario-based trainings where the officers will be set up with a scenario and then simulating a mental health crisis and the officer has to use their skills to help calm that person down.

Pence: CIT also connects police officers to resources such as therapists and mental hospitals, where they may be able to refer a person instead of arresting them.

Usher: One of the last pieces is interaction with advocacy organizations like local NAMI-affiliated organizations where the officers learn about what are the resources in their community? Can they call on one of these organizations to provide support or education to some of the people that they’re encountering in crisis or to their families? Can they call on mental health services and who’s available at three in the morning? What services are available on the weekend?

Pence: It’s this preparation that allows officers to de-escalate situations effectively. Usher says it’s resulted in measurable improvements in the outcomes of police responses to mental health crises.

Usher: Officer injuries in responding to mental health calls have dropped by 80% in Memphis which is where the first CIT program started, and in other communities they’ve documented that people with mental illness who encounter a CIT officer spend on average two more months in the community than someone who may have encountered an untrained officer. And when I say “time in the community,” that means that the person received more counseling and more medication and they were less likely to be in jail or in the hospital.

Pence: That’s progress. But Neal says there is still room for improvement in the way police departments and correctional facilities handle people with mental illness.

Neal: These people are under serious hallucinations, they are not and should not be held criminally responsible for their reactions to police officers, and every avenue to save their lives; every avenue to prevent catastrophic harm must be employed. So I feel that crisis intervention training will help to make that more possible. However, I want to interject that police officers must be held accountable for the training that they’ve already received. And they must be held accountable even to a higher level of accountability once they complete crisis intervention training. A lot of the death and serious injuries to mentally ill people are not the result of a lack of training, but they are the result of a lack of appropriate action that police officers and prison corrections according to what they already know to be right and wrong protocol.

Sam Cochran: Communities and counties are now coming together in meetings and in task force and committees to examine, okay what is CIT? And one of the discoveries that they’re going to have is that CIT is more than just training.

Pence: That’s Sam Cochran, a retired major in the Memphis Police Department who coordinated its CIT program for 20 years. Now he’s project coordinator at the University of Memphis CIT center. During Cochran’s tenure at the helm of the Memphis program, it developed into a blueprint for similar programs across the country.

Cochran: What have discovered over the many years that a better CIT program is one that engages significant community effort. The Crisis Intervention Team or the CIT program should be considered as a community program and not just a law enforcement program.

Pence: Cochran says CIT brings together three prongs of the community– the local police department, the local mental health agency, and advocacy organizations who represent mentally ill people and their families.

Cochran: There needs to be avenues by which law enforcement officers can divert an individual into the community without criminal charges being attached. When I say CIT is more than just training, that’s part of the “more,” to be able to make sure that we are giving that level of care in a balanced way. Okay, we have a person that has a mental illness and that person is creating some type of minor disturbance and the public that technically within the letter of the law could be charged with disorderly conduct or a criminal trespass or a disturbance of the peace. I’d also like that officer to have an understanding of the resources and availability of those resources to divert that individual back into the community to say, “Okay, let’s see what we could do to get this individual back to a pre-crisis level without having criminal charges attached to the individual.”

Pence: According to DuPont, many of us have misconceptions about mental illness and police are just as subject to them as the rest of us. For example, Neal says it’s only natural for an officer to be fearful and assume there may be danger if someone’s taken the trouble of calling for police. DuPont says proper training and public awareness are key to reaching out to people who suffer from mental illness.

DuPont: One thing that’s, I think, important is to understand that often those of us that may not have the experience of serious mental illness, we view mental illness as something that’s just a matter of degree – well, it’s a bit worse or it’s a little different. Individuals that have experienced serious mental illness experience a qualitative difference in the way that the world is seen and what’s going on. It’s very challenging and it’s not something that I think you or I, unless we have had very unique experiences, can fully comprehend so it’s easy to sort of for people to misjudge it.

Pence: You can learn more about all our guests by visiting our website at radiohealthjournal.net. Our writer/producer this week is Eli Murray. I’m Reed Pence.

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