The intersection of law enforcement and mental health crises represents one of the most critical touchpoints in public safety and community health. In the United States, police officers are frequently the primary, and sometimes sole, first responders to individuals in acute psychological distress. The stakes of these encounters are profoundly high; data from 2018 indicates that approximately 1,000 individuals were fatally shot by police officers, with people with mental illness (PMI) accounting for roughly 25 percent of those fatalities. This static rate of fatality between 2015 and 2018 underscores the urgent need for specialized training and systemic reform in how emergency services engage with populations experiencing mental, emotional, or developmental challenges.
The Crisis Intervention Team (CIT) model has emerged as a dominant paradigm to address these challenges. By shifting the police response from a purely tactical approach to one grounded in crisis intervention and diversion, CIT aims to reduce the risk of serious injury or death during emergency interactions. This systemic approach integrates law enforcement, mental health providers, and the community to foster a more humane, calm, and effective response to psychiatric emergencies.
The Conceptual Framework of the CIT Model
The CIT model is designed as a community partnership that bridges the gap between the criminal justice system and the mental health care continuum. Rather than viewing a mental health crisis through the lens of criminal non-compliance, the CIT framework treats these encounters as medical and psychological emergencies requiring specialized intervention.
The primary objective of the CIT model is to provide a system of services that is accessible and "friendly" to individuals with mental illness, their families, and the officers themselves. This is achieved by establishing a standard of excellence for officers regarding the treatment of PMI, moving away from stereotypes and stigma toward a service-oriented approach.
Core Components of Implementation
The "Memphis model," which serves as a foundational blueprint for CIT, emphasizes specific structural elements to ensure efficacy:
- Selection Process: CIT is not mandatory for all officers; it is designed for self-selected officers who demonstrate an aptitude and interest in mental health crisis work.
- Intensive Training: The curriculum consists of 40 hours of specialized instruction. This training is multidisciplinary, featuring input from community mental health workers, individuals with lived experience of mental illness, family advocates, and experienced CIT officers.
- Integrated Service Delivery: Unlike fragmented responses, CIT seeks to combine the initial call and response triage with immediate access to specialized police officers and mental health professional intervention.
Typology of Emergency Responses to Mental Health Crises
To understand the position of CIT within the broader landscape of emergency services, it is helpful to categorize police responses into a tripartite typology based on the nature of the responder and the source of the expertise.
| Response Type | Primary Agent | Operational Mechanism | Example |
|---|---|---|---|
| Police-Based Specialized Response | Sworn Officers | Officers receive specialized training to act as first responders and coordinate with community mental health resources. | Crisis Intervention Team (CIT) |
| Police-Based Specialized Mental Health Response | Non-Sworn Employees | Mental health-trained police staff provide remote or on-site consultation to sworn officers in the field. | Centralized Resource Centers |
| Mental-Health-Based Specialized Response | Mental Health Workers | Independent mental health systems act as primary agents, often operating independently or in tandem with police. | Mobile Crisis Units / Street Triage |
Comparative Analysis of Specialized Intervention Models
While CIT is widely implemented, other specialized models exist, such as "liaison and diversion" and "street triage." These models differ primarily in their goals and the point of intervention.
- Liaison and Diversion: The primary goal of this model is diversion. Specialist mental health-trained staff are positioned at police custody sites or within the court system to identify mental health needs and divert individuals away from incarceration toward treatment.
- Street Triage: This model prioritizes timely access to mental health services. It involves the deployment of mobile crisis units and specialized mental health-trained staff based on individualized protocols.
Research comparing these models suggests that while each produces beneficial effects compared to control groups, the CIT model is often viewed as the most comprehensive because it offers an integrated service that combines the initial dispatch response with professional mental health intervention.
Clinical and Operational Outcomes of CIT
The evaluation of CIT effectiveness is complex, often resulting in a dichotomy between subjective officer experiences and objective clinical data.
Officer-Level Benefits
There is strong evidence that CIT training yields significant positive outcomes for the officers themselves. These include: - Increased Officer Satisfaction: Officers report higher levels of job satisfaction and confidence when handling psychiatric crises. - Self-Perception of Force Reduction: CIT-trained officers generally perceive themselves as using less force and relying more on verbal negotiation. - Reduction of Stigma: The program serves as a potent agent for overcoming negative stereotypes associated with mental illness, leading to a more humane and calm approach during interactions.
Systemic and Diversionary Impacts
One of the most successful outcomes of the CIT model is the shift in the trajectory of the encounter. CIT likely leads to prebooking diversion, meaning individuals are diverted from jails into psychiatric facilities before they are officially processed into the criminal justice system. This reduces the criminalization of mental illness and ensures that patients receive medical care rather than incarceration.
The "Evidence Gap" in Objective Measures
Despite the perceived benefits, a tension exists in the peer-reviewed literature regarding objective metrics. While some studies show an increase in verbal negotiation and a higher likelihood of referral to mental health units, other data points are less clear: - Use of Force: Some research indicates no measurable difference in the objective use of force between CIT-trained officers and those without training. - Injury Rates: There is limited, and sometimes contradictory, evidence showing a definitive reduction in injuries to officers or citizens. - Arrest Rates: While diversion is more common, the overall reduction in arrests across large populations remains a subject of ongoing study.
One hypothesis for this gap is that "environmental effects"—such as the volatility of the crisis, the surrounding neighborhood, or the severity of the psychiatric episode—may overwhelm the detectable effects of CIT training, masking the positive impact that the training may have on individual encounters.
Challenges in Evaluation and Research
The difficulty in establishing a definitive "success rate" for CIT stems from several methodological hurdles in the criminal justice and mental health arenas.
- Heterogeneity of Implementation: Because CIT is implemented across thousands of different jurisdictions, the "model" varies. This makes quantitative comparisons and meta-analyses challenging.
- Lack of Standardized Definitions: There is a lack of agreement among researchers and practitioners regarding what constitutes a "mental health crisis call," leading to inconsistent data collection.
- Absence of Intention-to-Treat Analyses: Many studies fail to use rigorous experimental designs, making it difficult to isolate the effect of the training from other variables.
- Divergent Terminology: The mental health and criminal justice sectors use different languages and metrics to measure success, which complicates the creation of unified analyses.
Conclusion
The Crisis Intervention Team (CIT) model represents a critical evolution in community policing, moving away from a one-size-fits-all tactical response toward a nuanced, trauma-informed approach. By prioritizing verbal negotiation, reducing the stigma of mental illness, and facilitating the diversion of individuals from jails to psychiatric facilities, CIT addresses the systemic failures that have historically led to tragic outcomes in police-PMI interactions.
While objective data on the reduction of injuries and use of force remains contested due to methodological challenges, the qualitative improvements in officer confidence and the systemic shift toward healthcare diversion provide a compelling argument for the model's utility. The integration of self-selected officers, multidisciplinary training, and community partnerships ensures that the response to a mental health crisis is governed by clinical necessity rather than criminal suspicion.