The way we treat the mentally ill in this country is a crime

The incident involving Sheehan started when social worker Heath Hodge believed Sheehan’s schizophrenia had deteriorated to “gravely disabled” after Sheehan stopped taking her medication, and called police for help transporting her to a mental health facility for involuntary commitment and treatment.

When police showed up at the San Francisco group home where Sheehan lived without a warrant, Sheehan “reacted violently,” wielding a knife and telling the officers she would kill them. In response, officers safely retreated to a hallway. “The officers called for backup,” the Ninth Circuit decision explained, “but rather than waiting for backup or taking other actions to maintain the status quo or de-escalate the situation, the officers drew their weapons and forced their way back into Sheehan’s room, presumably to disarm, subdue and arrest her, and to prevent her escape (although there do not appear to have been any means of escape available). Sheehan once again threatened the officers with a knife, causing the officers to shoot Sheehan five or six times.”

Sheehan argued that officers failed to reasonably accommodate her disability by “forcing their way back into her room without taking her mental illness into account and without employing tactics that would have been likely to resolve the situation without injury to herself or others.”

And expert witness Lou Reiter provided testimony that officers, in fact, did not follow that protocol at all. He said officers are trained not to agitate or excite individuals who are mentally ill, to “respect the person’s comfort zone, use nonthreatening communications and to employ the passage of time to their advantage.” He also cited materials used by the San Francisco Police Department that advise officers to request backup, to calm the situation, to communicate, to move slowly, to assume a quiet, nonthreatening manner, to take time to assess the situation and to “give the person time to calm down.”

“Reiter deemed the officers’ second entry into Sheehan’s home tactically unreasonable under those policies,” the lower court noted, finding that the officers should have awaited back-up and considered seeking a warrant.

In Monday’s opinion, the justices noted that whether the officers followed training protocol is not a factor in granting police officers what is known as “qualified immunity,” the broad federal protection that shields the police and other government entities from civil rights lawsuits.

“Considering the specific situation confronting Reynolds and Holder, they had sufficient reason to believe that their conduct was justified,” Justice Samuel Alito wrote for the court.

Crisis Intervention Team (CIT) Training is a training program developed in a number of U.S. states to help police officers react appropriately to situations involving mental illness or developmental disability.

Communities large and small are seeking answers to managing crisis issues and crisis services. When changes are mandated, community collaborations and partnerships are the key. Advocates have long asserted that law enforcement personnel do not receive adequate mental health training, resulting in ineffective and sometimes fatal encounters or outcomes. In 1988, Memphis introduced the first crisis intervention team as a component to the community’s demand for safer, first responder crisis services.

CIT partnerships led to changes in existing systems and stimulated the development of new infrastructures for services. Suicide attempts and mental health crisis concerns are recognized as a priority. Crises are about people, about our community, our families, our friends, and our loved ones. CIT is founded on principles of dignity, understanding, kindness, hope and dedication.

Calls involving persons experiencing mental health crises can be particularly problematic for police officers. Surveys of officers suggest that they do not feel adequately trained to effectively respond to mental health crises, that mental health calls are very time-consuming and divert officers from other crime fighting activities, and that mental health providers are not very responsive. Officers perceive mental health related calls as very unpredictable and dangerous, which without adequate training in de-escalation, could inadvertently cause them to approach in a manner which escalates the situation. As media reports confirm, on rare occasions, mental health related calls do end in horrible tragedies, with officers or persons with mental illness being seriously or fatally wounded.

THE CIT MODEL
It was a tragedy that spurred the coming together of stakeholders to develop the original CIT program in Memphis, TN. In 1988, following the fatal shooting of a man with a history of mental illness and substance abuse by a Memphis police officer, a community task force comprised of law enforcement, mental health and addiction professionals, and mental health advocates collaborated to develop what is now internationally known as the Memphis CIT model. The primary goals of the model are to increase safety in encounters and when appropriate, divert persons with mental illnesses from the criminal justice system to mental health treatment.

While the centerpiece of the model is 40 hours of specialized training for a select group of officers that volunteer to become CIT officers, proponents stress that CIT is more than just training (CIT International, 2012). CIT is an organizational and community intervention that involves changes in police department procedures as well as collaboration with mental health providers and other community stakeholders. According to the model, officers volunteer to receive 40 hours of training provided by mental health clinicians, consumer and family advocates, and police trainers. Training includes information on signs and symptoms of mental illnesses; mental health treatment; co-occurring disorders; legal issues and de-escalation techniques. CIT curriculums may also include content on developmental disabilities, older adult issues, trauma and excited delirium. Information is presented in didactic, experiential and practical skills/scenario based training formats. The training week may include panels of providers, family members and persons with mental illnesses as well as site visits to agencies in the community (Compton et al., 2011).

Call dispatchers are trained to identify mental disturbance calls and assign these calls to CIT trained officers. CIT officers are trained to uses de-escalation techniques if necessary and assess if referral to services or transport for mental health evaluation is appropriate. An important component of the model is a central designated psychiatric emergency drop-off site with a no refusal policy. This allows the officer to transport an individual for emergency evaluation and treatment and get back out on the street to his or her other duties in a timely manner. Additionally, during training and after, CIT officers familiarize themselves with a variety of mental health services in the community that they can utilize to resolve mental health related calls.

Enthusiasm about the CIT model has spread quickly as police agencies struggle to demonstrate greater responsiveness to the significant numbers of persons with mental illness they encounter. Current estimates suggest that worldwide, there are over 1,000 CIT programs being implemented.