1. Law Enforcement Responses to People with Mental Illnesses: Improving Outcomes Brought to you by the National Council and the Council of State Governments Justice Center, with support from the Bureau of Justice Assistance, U.S. Department of Justice © CSG Justice Center, New York, NY

2. The Challenge for Law Enforcement *

3. What Is the Problem? People with mental illnesses, substance use disorders, and co-occurring disorders are significantly overrepresented in the criminal justice system.

4. Criminal Justice Populations Are Skyrocketing 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.http://www.ojp.usdoj.gov/bjs/glance/corr2.htm

5. 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.http://www.pewcenteronthestates.org/report_detail.aspx?id=35904

6. Scope of the Problem Over 14 million arrests each year, involving more than 9 million adults. Over 14 million arrests each year, involving more than 9 million adults. Over 1 million arrestees have serious mental illnesses. Over 1 million arrestees have serious mental illnesses. 75% of those with serious mental illnesses have co-occurring substance use disorders. 75% of those with serious mental illnesses have co-occurring substance use disorders. The vast majority will be released to the community. The vast majority will be released to the community.

7. Specialized Law Enforcement-Based Response Initiatives Enhance traditional law enforcement roles to provide a new set of response options for frontline personnel tailored to the needs of people with mental illnesses Enhance traditional law enforcement roles to provide a new set of response options for frontline personnel tailored to the needs of people with mental illnesses When appropriate, establish a link for these individuals to services in the community When appropriate, establish a link for these individuals to services in the community Ensure law enforcement-based agencies have strong collaborative ties to mental health partners, other criminal justice agencies, and community providers Ensure law enforcement-based agencies have strong collaborative ties to mental health partners, other criminal justice agencies, and community providers

8. Law Enforcement Responses *

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

10. Law Enforcement Concerns Law enforcement officers lack information and skills to de-escalate crises, and information and skills to de-escalate crises, and reliable and efficient access to mental health services. reliable and efficient access to mental health services. These calls for service are complex, time-consuming, and potentially volatile. These calls for service are complex, time-consuming, and potentially volatile. The largest psychiatric inpatient facilities in the United States today are actually jails –Rikers Island in New York City and the Los Angeles County Jail. The largest psychiatric inpatient facilities in the United States today are actually jails –Rikers Island in New York City and the Los Angeles County Jail.

11. What Are Specialized Law Enforcement Responses? Programs that are law enforcement-based include Crisis intervention teams: A self-selected cadre of officers trained to identify signs and symptoms of mental illness, de-escalate the situation, and bring the person in crisis to an efficient, round- the-clock treatment center. Crisis intervention teams: A self-selected cadre of officers trained to identify signs and symptoms of mental illness, de-escalate the situation, and bring the person in crisis to an efficient, round- the-clock treatment center. Co-responder teams: A specially-trained officer paired with a mental health professional to respond to the scene of a crisis involving mental illness. Co-responder teams: A specially-trained officer paired with a mental health professional to respond to the scene of a crisis involving mental illness.

12. Outcomes Reduced officer injuries Reduced officer injuries CIT officer injury rates in Memphis (TN) decreased from one in every 28,571 events in the three-year period prior to implementing CIT, to one in every 142,857 events in the years following implementation (Dupont & Cochran, 2000). CIT officer injury rates in Memphis (TN) decreased from one in every 28,571 events in the three-year period prior to implementing CIT, to one in every 142,857 events in the years following implementation (Dupont & Cochran, 2000). The San Jose (CA) Police Department’s CIT program reported a 32% decrease in officer injuries over a one-year period following program implementation (Reuland, 2004). The San Jose (CA) Police Department’s CIT program reported a 32% decrease in officer injuries over a one-year period following program implementation (Reuland, 2004).

13. Outcomes Reduced SWAT call-outs Reduced SWAT call-outs The rate of TACT (similar to SWAT) calls in Memphis has decreased by nearly 50% since the implementation of CIT (Dupont & Cochran, 2000). The rate of TACT (similar to SWAT) calls in Memphis has decreased by nearly 50% since the implementation of CIT (Dupont & Cochran, 2000). Since the implementation of CIT in Albuquerque (NM), the use of SWAT teams involving a mental health crisis intervention has decreased 58% (Bower & Pettit, 2001). Since the implementation of CIT in Albuquerque (NM), the use of SWAT teams involving a mental health crisis intervention has decreased 58% (Bower & Pettit, 2001).

14. Outcomes Reduced arrest rates Reduced arrest rates Law enforcement-based programs made arrests in only 2% - 5% of calls involving a person with mental illness, as compared with a 13% arrest rate in the mental health-based approach (Steadman et al., 2000). Law enforcement-based programs made arrests in only 2% - 5% of calls involving a person with mental illness, as compared with a 13% arrest rate in the mental health-based approach (Steadman et al., 2000). Individuals with mental illnesses who are diverted from jail spent more time in the community without a concomitant increase in arrest (Steadman & Naples, 2005). Individuals with mental illnesses who are diverted from jail spent more time in the community without a concomitant increase in arrest (Steadman & Naples, 2005). An analysis of Houston’s (TX) 1,439 CIT calls revealed that only 17 people with mental illnesses had been arrested (Reuland, 2004). An analysis of Houston’s (TX) 1,439 CIT calls revealed that only 17 people with mental illnesses had been arrested (Reuland, 2004).

15. Outcomes Increased access to mental health services Increased access to mental health services People diverted from jail had significantly greater access to crisis services (emergency room and hospitalization) and non- crisis services (medication and counseling) than people who were not diverted from jail (Steadman & Naples, 2005). People diverted from jail had significantly greater access to crisis services (emergency room and hospitalization) and non- crisis services (medication and counseling) than people who were not diverted from jail (Steadman & Naples, 2005). CIT-trained officers in Akron transported people with mental illnesses to psychiatric emergency services significantly more often than their non-CIT-trained counterparts. This study showed no difference between the two groups in numbers of arrests (Teller et al., 2006). CIT-trained officers in Akron transported people with mental illnesses to psychiatric emergency services significantly more often than their non-CIT-trained counterparts. This study showed no difference between the two groups in numbers of arrests (Teller et al., 2006). In Memphis’ CIT program, the referral rate from law enforcement to the emergency service increased by 42% in its first four years (Dupont & Cochran, 2000). In Memphis’ CIT program, the referral rate from law enforcement to the emergency service increased by 42% in its first four years (Dupont & Cochran, 2000).

16. How Do the Essential Elements Help? The 10 elements were derived from recommendations made by a broad range of practitioners and other subject matter experts. The 10 elements were derived from recommendations made by a broad range of practitioners and other subject matter experts. They provide a common framework for program design and implementation to promote positive outcomes. They provide a common framework for program design and implementation to promote positive outcomes. They are sensitive to the distinct needs and resources of a particular jurisdiction. They are sensitive to the distinct needs and resources of a particular jurisdiction. As such, they reflect a process-oriented approach rather than a model replication approach. As such, they reflect a process-oriented approach rather than a model replication approach.

17. What Are the 10 Essential Elements of a Law Enforcement-Based Response? 1. Collaborative Planning and Implementation 2. Program Design 3. Specialized Training 4. Call-Taker and Dispatcher Protocols 5. Stabilization, Observation, and Disposition

18. What Are the 10 Essential Elements of a Law Enforcement-Based Response? 6. Transportation and Custodial Transfer 7. Information Exchange and Confidentiality 8. Treatment, Supports, and Services 9. Organizational Support 10. Program Evaluation and Sustainability

19. A View from the Street *

20. In 2007, the Los Angeles Police Department received 71,469 calls for service that involved mental illness.

21. 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.

22. CAMP Case Assessment Management Program

23. 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.

24. 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?

25. 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

26. 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

27. 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.

28. Patient Privacy Separate databases Need to know and right to know

29. 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

30. 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.

31. 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.

32. 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

33. For More Information To download Improving Responses to People with Mental Illnesses, go to http://consensusproject.org/dow nloads/le-essentialelements.pdf. http://consensusproject.org/dow nloads/le-essentialelements.pdf Print copies may also be ordered from the National Criminal Justice Reference Service at http://www.ncjrs.gov/App/Publi cations/abstract.aspx?ID=245259. http://www.ncjrs.gov/App/Publi cations/abstract.aspx?ID=245259

34. Council of State Governments Justice Center 4630 Montgomery Avenue, Suite 650 Bethesda, MD 20814 www.justicecenter.csg.org 100 Wall Street, 20th Floor New York, NY 10005