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Zoeteman JB, de Wit MAS, de Haas HJ, Borkent KM, Peen J, Mulder CL, Dekker J. Coercion During Psychiatric Ambulance Versus Police Transport in Mental Health Crises: A Pre- and Postimplementation Study. Psychiatr Serv 2024:appips20230571. [PMID: 38807576 DOI: 10.1176/appi.ps.20230571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE Police officers are often the first responders when individuals experience a mental health crisis and typically remain responsible for transport to a psychiatric emergency department. In 2014, a psychiatric ambulance (PA) was introduced in the city of Amsterdam to take over the transport of individuals in a mental health crisis. The purpose of the PA was to use fewer restrictive measures while guaranteeing safety for both patients and personnel. METHODS A preimplementation-postimplementation design was used to assess the feasibility and utility of a single-vehicle PA service compared with police transport. Data on 498 rides were collected in the 4 months before implementation of the PA (pre-PA cohort) and on 655 rides in the 6 months after implementation (PA cohort). RESULTS After PA implementation, most patients were transported by the PA (82%), and rides by police vehicle were very rare (1%). Individuals in the PA cohort had a greater transportation delay, compared with those in the pre-PA cohort, but the PA reduced use of coercive measures with no increase in the incidence of patient aggression. Among individuals in the PA cohort, hospitalization was more often voluntary than among those in the pre-PA cohort. CONCLUSIONS Transporting emergency psychiatric patients by a special PA rather than by the police reduced the use of coercive measures during transport, kept the occurrence of aggressive incidents stable, and was associated with fewer coercive hospital admissions.
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Affiliation(s)
- Jeroen B Zoeteman
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Mathilde A S de Wit
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Hans J de Haas
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Kate M Borkent
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Jaap Peen
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Cornelis L Mulder
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
| | - Jack Dekker
- Psychiatric Emergency Service Amsterdam (Zoeteman), Inforsa (de Haas), and Department of Research (Peen, Dekker), Arkin Mental Health Care, Amsterdam; Department of Healthy Living, Public Health Service Amsterdam, Amsterdam (de Wit); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (de Haas); Ambulance Amsterdam, Amsterdam (Borkent); Epidemiological and Social Psychiatric Research Institute, Erasmus Medical Center, and Parnassia Psychiatric Institute, Rotterdam (Mulder)
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Anestis JC, Halkitis PN, Cordeiro A, Lanman MJ, Passannante MR. ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program. Behav Med 2024:1-10. [PMID: 38449435 DOI: 10.1080/08964289.2024.2324793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Perry N Halkitis
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Alana Cordeiro
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, USA
| | - Melissa J Lanman
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
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Wood LL, Barrenger S, Bonfine N. Contextual Factors of Mental Health Crisis Calls to Law Enforcement: A Brief Report. Community Ment Health J 2024; 60:403-409. [PMID: 37768479 DOI: 10.1007/s10597-023-01185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Law enforcement officers are frequent first responders to people experiencing mental health or suicide crises. Yet, as communities consider expanding crisis response options, we know very little about the nature of these calls that could inform decision making about which crisis response is best suited for the situation. This study is an exploratory, descriptive assessment of contextual factors, both individual and situational, of mental health and suicide crisis calls. Our dataset includes 166 calls to 9-1-1 related to a mental health emergency or suicide crisis. The majority were calls related to suicide (125 calls, 75%), which included more contextual factors than mental health crisis calls. Most calls resulted in the subject being transferred to the local emergency department (60%) or were resolved on scene (12%). Police use of force was rare, and no arrests were reported. The implications of these findings for communities developing alternatives to law enforcement crisis response are discussed.
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Affiliation(s)
- Leslie L Wood
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown, OH, USA.
- Department of Sociology and Criminology, Kent State University, Kent, OH, USA.
| | - Stacey Barrenger
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, Rootstown, OH, USA
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Compton MT, Pope LG, de Bibiana JT, Boswell T, Fu E, Zern A, Bello I, Broussard B, Ford E, Jones N, Monahan Pollard J, Watson AC, Dixon L. Changes in knowledge, behavioural expectations, self-efficacy, and stigma after an educational campaign about early psychosis for jail correction officers. Early Interv Psychiatry 2023; 17:798-806. [PMID: 36641811 DOI: 10.1111/eip.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/29/2022] [Accepted: 01/02/2023] [Indexed: 01/16/2023]
Abstract
AIM Given a lack of interventions to identify and engage individuals with early psychosis in jail and connect them to specialty care in the community upon release, we designed a Targeted Educational Campaign (TEC) for correction officers working in jails. We report on impacts of the TEC on officers' cognitive and attitudinal outcomes. METHODS Three different cohorts of officers-totaling n = 451-took part in a survey: 200 at baseline before the TEC began, 123 at 6-months into the TEC, and 128 at 12-months into the TEC. Among each cohort of officers, four constructs were measured: (1) knowledge about early psychosis; (2) self-efficacy around detecting early psychosis and referring to mental health services within the jail; (3) expectations about the benefits of detection and referral to specialty care; and (4) social distance stigma toward detainees with early psychosis. RESULTS While exposure to TEC elements was as-planned in the first 6-months, exposure diminished substantially at 12-months, coinciding with increasing fatigue among correction officers due to the COVID-19 pandemic as well as serious staffing shortages. Knowledge, behavioural expectations, and self-efficacy scores improved from baseline to 6-months, with greater exposure to roll-call messages driving scores. Knowledge and behavioural expectations at 12-months were associated with having received an information post card. Social distance stigma worsened across timepoints. CONCLUSIONS An educational campaign for jail staff can enhance knowledge, self-efficacy, and behavioural expectations regarding early psychosis, though only while the campaign elements are active. Further research should investigate whether or not social distance stigma or other types of stigma increase alongside improvements.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | | | - Tehya Boswell
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - En Fu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth Ford
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Nev Jones
- University of Pittsburgh School of Social Work, Pittsburgh, Pennsylvania, USA
| | - Jessica Monahan Pollard
- State of Maine Department of Health and Human Services, Office of Behavioral Health, Augusta, Maine, USA
| | - Amy C Watson
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
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Nicholson TP, Blazer EC, Hymes AS, Ginley MK. A Qualitative Investigation into the Trauma Exhibited by First Responders Impacted by the Opioid Epidemic. Int J Ment Health Addict 2023:1-22. [PMID: 36619000 PMCID: PMC9810250 DOI: 10.1007/s11469-022-00993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
This qualitative study aimed to capture the lived experiences of first responders (FRs) combatting the opioid epidemic in an effort to better understand how the increase in opioids, opioid-related harm, and opioid-related death has affected the FR profession. FRs (N = 30) from Tennessee partook in semi-structured interviews investigating the impact of responding to opioid-related incidents. Using a phenomenological approach, three response themes emerged including (1) opioid epidemic burden on FR mental health, (2) variable availability and effectiveness of resources, and (3) identified roles of FRs in reducing the impact of the epidemic. The findings indicate that FRs are experiencing posttraumatic stress and secondary traumatic stress symptoms due to a shift in their duties, as well as repeated exposures to the adverse impacts of opioid use. This study finds a deficit in resources and support to combat the mental health repercussions FRs have experienced due to the epidemic. Given that FRs are often directly involved in preventing opioid-related deaths, ensuring that they are well resourced is an essential component of harm reduction and will ultimately augment care for individuals experiencing opioid-related harm.
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Affiliation(s)
- Thalia P. Nicholson
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
| | - Erin C. Blazer
- Department of Counseling, Carson Newman, 1646 Russell Avenue, Jefferson City, TN 37760 USA
| | - Aaron S. Hymes
- Department of Counseling, Milligan University, P.O. Box 22, Milligan, TN 37682 USA
| | - Meredith K. Ginley
- Department of Psychology, East Tennessee State University, 420 Rogers Stout-Hall, P.O. Box 70649, Johnson City, TN 37614 USA
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Tartaro C, Bonnan-White J, Mastrangelo MA, Erbaugh E, Mulvihill R. Comparisons of beliefs in mental health stigma in communities and those who police them. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 86:101853. [PMID: 36521280 DOI: 10.1016/j.ijlp.2022.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 10/03/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The police response towards people with mental illness (PwMI) is coming under increasingly intense scrutiny. Numerous jurisdictions have experienced incidents where the police have used force against persons who were exhibiting symptoms of severe mental illness. PwMI are subject to long-held stereotypes and stigma, and recent research indicates these negative attitudes remain, even with training and awareness campaigns. Available literature provides research on citizen and police perceptions of PwMI separately, but no recent studies have compared perceptions of police officers to those held by the members of the communities they patrol. The current study involves a comparison of residents in five southern New Jersey counties and police officers working in these same counties. Both sets of participants responded to a series of statements about perceptions of PwMI. Police were more likely to report supporting stigmatizing views of PwMI than were community members. Negative community response and rejection of police tactics may be rooted partly in differing expectations of treatment towards PwMI in crisis.
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Crisis Intervention Team (CIT) training and impact on mental illness and substance use-related stigma among law enforcement. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100099. [PMID: 36844168 PMCID: PMC9949319 DOI: 10.1016/j.dadr.2022.100099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
Abstract
Limited empirical data and research exists about stigmatizing attitudes and perceptions held by law enforcement officers towards persons with mental illness and substance use issues. Pre- and post-training survey data from 92 law enforcement personnel who attended a 40-hour Crisis Intervention Team (CIT) training was used to investigate training-related changes in mental illness stigma and substance use stigma. Training participant's mean age was 38.35 ± 9.50 years, majority white non-Hispanic race/ethnicity (84.2%), male gender (65.2%), and reported job category as road patrol (86.9%). Pre-training, 76.1% endorsed at least one stigmatizing attitude towards people with mental illness, and 83.7% held a stigmatizing attitude towards those with substance use problems. Poisson regression revealed that working road patrol (RR=0.49, p<0.05), awareness of community resources (RR=0.66, p<0.05), and higher levels of self-efficacy (RR=0.92, p<0.05) were associated with lower mental illness stigma pre-training. Knowledge of communication strategies (RR=0.65, p<0.05) was associated with lower pre-training substance use stigma. Post-training, improvement in knowledge of community resources and increases in self-efficacy were significantly associated with decreases in both mental illness and substance use stigma. These findings highlight the existence of stigma related to both mental illness and substance use pre-training suggesting the need for implicit and explicit bias training prior to the start of active law enforcement duty. These data are consistent with prior reports indicating CIT trainings as a path to address mental illness and substance use stigma. Further research on effects of stigmatizing attitudes and additional stigma-specific training content is warranted.
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Compton MT, Krishan S, Broussard B, Bakeman R, Fleischmann MH, Hankerson-Dyson D, Husbands L, Stewart T, D'Orio B, Del Pozo B, Watson AC. Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals. Community Ment Health J 2022; 58:1112-1120. [PMID: 34812962 PMCID: PMC9197601 DOI: 10.1007/s10597-021-00920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
The Theory of Planned Behavior posits that behaviors are predicted by one's intention to perform them; intention is driven by attitude toward the behavior, subjective norm, and perceived behavioral control. We used this theory to predict Crisis Intervention Team (CIT)-trained and non-CIT officers' intention to facilitate referral of persons with suspected mental illnesses to mental health services. CIT-trained (n = 251) and non-CIT (n = 335) officers from six law enforcement agencies participated. CIT-trained officers had significantly greater scores on all constructs. Theory constructs fit the data well, and fit did not differ meaningfully between the two groups. Direct and indirect predictors together accounted for 28% and 21%, respectively, of variance in behavioral intention. Attitude was the strongest predictor. Intentions to facilitate mental health referrals may be driven by the same factors among CIT-trained and non-CIT officers, but CIT officers, even at a median of 22 months after training, have significantly higher scores on those factors.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 722 W. 168th Street, Room R249, New York, NY, 10032, USA. .,New York State Psychiatric Institute, New York, NY, USA.
| | - Shaily Krishan
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | - Beth Broussard
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Roger Bakeman
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Matthew H Fleischmann
- Department of Educational & Counselling Psychology, McGill University, Montreal, Quebec, Canada
| | - Dana Hankerson-Dyson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Letheshia Husbands
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Barbara D'Orio
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Brandon Del Pozo
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy C Watson
- Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Compton MT, Krishan S, Broussard B, Bakeman R, Fleischmann MH, Hankerson-Dyson D, Husbands L, Stewart T, D'Orio B, Watson AC. Modeling the effects of Crisis Intervention Team (CIT) training for police officers: How knowledge, attitudes, and self-efficacy drive de-escalation skills and referral decisions. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 83:101814. [PMID: 35759936 DOI: 10.1016/j.ijlp.2022.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 11/29/2021] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Prior research on Crisis Intervention Team (CIT) training for police officers has demonstrated improvements in knowledge, attitudes, self-efficacy, and stigma, but how these factors work together to influence behavioral outcomes like de-escalation skills and referral decisions remains unstudied. METHOD 251 CIT-trained and 335 non-CIT officers completed in-depth surveys measuring these six constructs. We used structural equation modeling to test fit of the data to our hypothesized model and made indicated changes to improve fit. RESULTS An alternate 8-path model (with three paths originally hypothesized being removed) fit reasonably well, and allowing path coefficients to differ for CIT and non-CIT groups resulted in models with similar fit statistics. CONCLUSION CIT training enhances knowledge and attitudes, both of which have beneficial effects on stigma. Though an important outcome itself, lower stigma does not have an effect on de-escalation skills and referral decisions, though self-efficacy clearly does.
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Affiliation(s)
- Michael T Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Shaily Krishan
- Council of State and Territorial Epidemiologists, Atlanta, GA, USA
| | | | - Roger Bakeman
- Georgia State University, Department of Psychology, Atlanta, GA, USA
| | - Matthew H Fleischmann
- McGill University, Department of Educational & Counselling Psychology, Montreal, Quebec, Canada
| | | | | | | | | | - Amy C Watson
- University of Wisconsin-Milwaukee, Helen Bader School of Social Welfare, Milwaukee, WI, USA
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Balfour ME, Hahn Stephenson A, Delany-Brumsey A, Winsky J, Goldman ML. Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies. Psychiatr Serv 2022; 73:658-669. [PMID: 34666512 DOI: 10.1176/appi.ps.202000721] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just whether law enforcement should respond to behavioral health emergencies but how to reduce unnecessary law enforcement contact and, if law enforcement is responding, when, how, and with what support. This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.
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Affiliation(s)
- Margaret E Balfour
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Arlene Hahn Stephenson
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Ayesha Delany-Brumsey
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Jason Winsky
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
| | - Matthew L Goldman
- Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman)
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Law Enforcement Perceptions About Naloxone Training and Its Effects Post-Overdose Reversal. J Addict Nurs 2022; 33:80-85. [PMID: 35640211 DOI: 10.1097/jan.0000000000000456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Law enforcement officers (LEOs) often are the first responders to arrive at a scene of an opioid overdose. Thus, equipping LEOs as first responders with naloxone is necessary to prevent overdose deaths and a recommended strategy. However, little is known about how LEOs perceive naloxone training and their feelings after using naloxone to save a life. It is important to understand LEOs' experiences with naloxone so as to develop additional training materials that are relevant to the LEO experience. METHODS A descriptive exploratory study was conducted to explore the perceptions of LEOs about using naloxone in the field and to identify areas that should be included in future naloxone trainings. Interview data were obtained through face-to-face interviews with LEOs (N = 14) and analyzed using manifest content analysis. RESULTS LEOs changed their attitudes and beliefs toward naloxone after receiving training and experiencing a successful resuscitation. The change in attitudes was enhanced after saving a life. However, misconceptions about naloxone and lack of understanding about disease of addiction persisted even after training. CONCLUSION Future naloxone curriculum could benefit from additional lessons on the stigma of addiction, the disease of addiction, misconceptions about the safety of naloxone, strategies for postoverdose responses, and the role naloxone, which might play in a hopeful recovery.
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Costigan CL, Woodin EM, Duerksen KN, Ferguson R. Benefits and Drawbacks of Police Integration Into Assertive Community Treatment Teams. Psychiatr Serv 2022; 73:447-455. [PMID: 34615367 DOI: 10.1176/appi.ps.201900549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Assertive community treatment (ACT) teams provide outreach services to individuals coping with severe mental illness. Because such individuals are at increased risk for involvement with law enforcement, a model that integrates police officers into ACT teams (ACT-PI) was developed for ACT teams serving clients with or without forensic involvement. The goal of this study, conducted in British Columbia, was to evaluate the benefits and drawbacks of the ACT-PI model. METHODS Qualitative semistructured interviews were conducted with 21 ACT-PI clients (in 2017) and 22 ACT-PI staff (in 2018). Thematic analyses identified key themes related to the benefits and drawbacks of officer integration into the ACT-PI model. RESULTS Perceived benefits of police integration were opportunities for relationship building between officers and clients, improved safety, more holistic care due to embeddedness (i.e., effective interagency collaboration between police and health care providers), the prevention of future problems, and police officers' authority enhancing compliance. Perceived drawbacks included risk for legal consequences, stigma from police interaction, escalating distress of clients, low officer availability, and the risk for changing the nature of ACT teams. CONCLUSIONS Participants reported that the model of officer integration into ACT-PI teams may improve both client and staff well-being. In some communities, and with certain precautions, ACT-PI may be a viable model for ACT teams serving clients with and clients without a history of forensic involvement.
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13
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Lavoie JAA, Alvarez N, Kandil Y. Developing Community Co-designed Scenario-Based Training for Police Mental Health Crisis Response: a Relational Policing Approach to De-escalation. JOURNAL OF POLICE AND CRIMINAL PSYCHOLOGY 2022; 37:587-601. [PMID: 35250163 PMCID: PMC8882363 DOI: 10.1007/s11896-022-09500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Using the current empirical landscape of police responses to people in mental health crisis as a backdrop, this methods paper makes an argument for the central role of collaborative co-design and production by diverse community experts and stakeholders to build transformative specialized training for frontline officers. Subject matter experts (SMEs) from across key domains participated in focus groups and curriculum creation, with outputs being the co-development of a conceptual approach and an innovative experiential learning training program. Part 1 unpacks the team's conceptual development of a relational policing approach. This humanized method is shaped by procedural justice, trauma-informed, person-centred, and cultural safety frameworks. Part 2 details the co-production of a novel problem-based training method for a police service in Southern Ontario, Canada. The program centres on the acquisition of core competencies related to relational policing, de-escalation, and mental health crisis response. The training was designed to bring learners through a spectrum of authentic crisis scenarios: from observer-participant scenarios informed by Forum Theatre methods and targeted SME feedback to a range of high-fidelity assessment simulations that test officers' abilities to effectively communicate, de-escalate, and make decisions under stress. This program offers repeated opportunities for officers to practice alternative crisis management strategies in scenarios that might otherwise result in the use of force.
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Affiliation(s)
- Jennifer A. A. Lavoie
- Departments of Psychology and Criminology, Faculty of Human and Social Sciences, Wilfrid Laurier University, Brantford, ON Canada
| | - Natalie Alvarez
- Theatre and Performance Studies, School of Performance, Ryerson University, Toronto, ON Canada
| | - Yasmine Kandil
- Department of Theatre, University of Victoria, Victoria, BC Canada
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14
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Lamberti JS, Katsetos V, Jacobowitz DB, Weisman RL. Psychosis, Mania and Criminal Recidivism: Associations and Implications for Prevention. Harv Rev Psychiatry 2021; 28:179-202. [PMID: 32251070 DOI: 10.1097/hrp.0000000000000251] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
People with mental illness are overrepresented throughout the criminal justice system, including jail, prison, probation, and parole populations. Yet much disagreement remains about why this problem exists and how best to address it. This article specifically examines empirical evidence regarding the question of whether psychosis and mania are associated with criminal recidivism, and whether this association is predictive or causal in nature. Review of the current literature suggests that psychotic and manic symptoms are associated with increased likelihood of arrest and incarceration. In addition, current evidence shows that pharmacotherapy can reduce criminal recidivism among justice-involved adults with psychosis or mania. However, the extent to which the association between psychosis, mania, and criminal justice system involvement is causal remains uncertain. Also, the literature suggests that most crimes committed by people with schizophrenia spectrum disorders or bipolar I disorder may be driven by factors other than their psychotic or manic symptoms. These established "criminogenic needs" are more common among people with severe mental disorders than in the general population. For optimal prevention, those who serve justice-involved adults with psychosis or mania in community settings should consider addressing the full range of factors that potentially drive their criminal justice system involvement.
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Affiliation(s)
- J Steven Lamberti
- From the Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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15
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Watson AC, Owens LK, Wood J, Compton MT. The Impact of Crisis Intervention Team Response, Dispatch Coding, and Location on the Outcomes of Police Encounters with Individuals with Mental Illnesses in Chicago. POLICING (OXFORD, ENGLAND) 2021; 15:1948-1962. [PMID: 34659453 PMCID: PMC8507917 DOI: 10.1093/police/paab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Crisis Intervention Team (CIT) model has been implemented in over 3,000 communities across the USA. Research to date has shown beneficial results in terms of officers' knowledge, attitudes, self-efficacy, stigma, and force preferences. This study aimed to broaden the lens on the implementation context of CIT to examine whether factors in the environment and response process affect how calls are resolved. This study focused on several factors-CIT response, call location, and upstream decisions to pre-identify calls as mental health-related-that may impact call outcomes. Our findings suggest that CIT response, dispatch coding, and the places where calls originate play a role in shaping outcomes. More research is needed to unpack the effects of this wider CIT implementation environment.
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Affiliation(s)
- Amy C Watson
- Amy C. Watson, Helen Bader School of Social Welfare, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Linda K Owens
- Linda K. Owens, Carle Foundation Hospital, Champaign, IL, USA
| | - Jennifer Wood
- Jennifer Wood, Department of Criminal Justice, Temple University, Philadelphia, PA, USA
| | - Michael T Compton
- Michael T. Compton, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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16
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Lorey K, Fegert JM. Increasing Mental Health Literacy in Law Enforcement to Improve Best Practices in Policing-Introduction of an Empirically Derived, Modular, Differentiated, and End-User Driven Training Design. Front Psychiatry 2021; 12:706587. [PMID: 34408683 PMCID: PMC8365022 DOI: 10.3389/fpsyt.2021.706587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Law enforcement officers often have contact to persons who show symptoms of mental disorders. Adequately designed training is necessary for developing the best possible practices in policing when coming into contact with mentally ill people, and may help to expand their general knowledge on mental disorders. To achieve a sustainable implementation of training content in daily policing work, the acceptance and proactive integration of methods by the training participants is essential. Method: This study investigates an exemplary modular training curriculum based on a survey with 2,228 German police officers (28.2% female, 71.8% male) concerning their needs and challenges when coming into contact with persons with mental disorders. This empirical end-user driven approach was used to adapt existing training concepts to the current needs and interests of law enforcement personnel in order to maximize compliance. Results: The training program draft includes basic modules which are intended to be of direct interest to all police officers, such as mental disorders with high policing relevance, encountering suicidal patients, (non-directive) communication and de-escalation skills, and mental hygiene in policing. They are arranged in more specialized modules that address specific target group audiences within police forces and the training curriculum provides information about genuine risks and self-protection, trauma sensitivity, and interaction with children and victims among other contents. The self-selectable, modular, and empirically-based continued training program also includes an introduction to local mental health service professionals and networks, trialogue sequences, and situational role play scenarios. Conclusion: Due to frequent contact law enforcement officers have to mentally ill people, improved training designed to maximize knowledge and the integration of trained methods is necessary. Gaining acceptance and proactive support by trainees is ensured through end-user driven implementation of specialized and differentiated up-to-date training programs. Our results showcase how police officers' perspectives on persons with mental illnesses is a main aspect that can and should be used to encourage training course designs.
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Affiliation(s)
- Katharina Lorey
- Ministry of the Interior, Digitalisation and Local Government of Baden-Wuerttemberg, Stuttgart, Germany
- Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Jörg M. Fegert
- Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Center, Ulm, Germany
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17
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Huey L, Andersen J, Bennell C, Ann Campbell M, Koziarski J, Vaughan AD. Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.
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Affiliation(s)
- Laura Huey
- University of Western Ontario, London, ON, Canada
| | | | | | | | | | - Adam D. Vaughan
- Texas State University, School of Criminal Justice and Criminology, San Marcos, TX USA
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18
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Kruis NE, Merlo AV. A Preliminary Assessment of Stigma in Law Enforcement Officers’ Responses to Opioid Overdoses. JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620974076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Prior work has suggested that provider-based stigma of substance use disorders may be one barrier to fighting the opioid epidemic. However, to date, provider-based stigma has been afforded little attention in the context of the criminal justice system. The goal of the current study was to extend this line of research by examining the impact of provider-based stigma toward opioid using persons to beliefs about help that should be provided to persons experiencing an overdose among a sample of 208 police officers working in departments in the Northeastern Region of the United States. In addition, this study explores the relationship between provider-based stigma and the anticipated on-duty behavioral responses to opioid overdoses. Results from multivariable analyses indicate that certain dimensions of social stigma are significantly related to officers’ perceptions of help in varying directions, along with officers’ experiences with naloxone administration and departmental policy pertaining to the use of naloxone.
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19
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Murphy J, Russell B. Police Officers’ Views of Naloxone and Drug Treatment: Does Greater Overdose Response Lead to More Negativity? JOURNAL OF DRUG ISSUES 2020. [DOI: 10.1177/0022042620921363] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Police officers and emergency personnel are on the frontlines of the opioid crisis. This research examines police officer attitudes about naloxone administration, drug treatment, and their role in handling drug-related incidents through an online survey. Although officers view themselves as adequately trained in administering naloxone/Narcan, almost half (43%) believe there should be a limit on how often someone who overdoses receives Narcan and the majority (83%) view naloxone/Narcan as providing an excuse to continue drug use. Officers also view drug treatment as ineffective. Negative attitudes differed as a function of frequency of overdose responses; officers who responded to more overdose calls and administered naloxone more frequently demonstrate more pessimistic attitudes toward drug treatment and the use of naloxone/Narcan. Officers more frequently exposed to drug overdoses need education and training about drug addiction issues to decrease stigma and elicit greater empathy toward people struggling with addiction.
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20
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Abstract
Promoting population mental health and meeting the burdens of mental illness is a priority public health challenge of the 21st century. But too little attention has been placed on how to design and sustain the scope of strategies and commitments that credibly live up to the full breadth of that challenge. ThriveNYC is an effort by New York City to fill that gap, through a public health approach backed by investment in resources and leadership. ThriveNYC can by example help mobilize a larger community of investigators and policymakers to consider how to meet this challenge, to get to consensus on key elements for effective action and implementation, to reimagine who and what the mental health "system" includes, and, in doing so, to strengthen the social contract that underlies well-being.
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Affiliation(s)
- Gary Belkin
- Gary Belkin is with the Office of the Mayor, New York, NY. Chirlane McCray is First Lady of New York City
| | - Chirlane McCray
- Gary Belkin is with the Office of the Mayor, New York, NY. Chirlane McCray is First Lady of New York City
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21
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Abstract
De-institutionalization of mental health patients has evolved, over nearly 3 generations now, to a status quo of mental health patients experiencing myriad contacts with first-responders, primarily police, in lieu of care. The current institutions in which these patients rotate through are psychiatric emergency units, emergency rooms, jails, and prisons. Although more police are now specially trained to respond to calls that involve mental health patients, the criminalization of persons with mental illness has been steadily increasing over the past several decades. There have also been deaths. The Crisis Intervention Team (CIT) model fosters mental health acumen among first responders, and facilitates collaboration among first responders, mental health professionals, and mental health patients and their families. Here, we review some modern, large city configurations of CIT, the co-responder model, the mitigating effects of critically situated community-based programs, as well as barriers to the success of joint efforts to better address this pressing problem.
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22
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D Booty M, G Williams R, K Crifasi C. Evaluation of a Crisis Intervention Team Pilot Program: Results from Baltimore, MD. Community Ment Health J 2020; 56:251-257. [PMID: 31641911 DOI: 10.1007/s10597-019-00474-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
The Crisis Intervention Team (CIT) program was developed as a resource on which police officers could rely when responding to behavioral health calls for service. Baltimore Police Department (BPD) piloted the CIT program in its Central District to address concerns regarding officer attitudes toward and treatment of persons experiencing behavioral health crises. This study used mixed methods to evaluate the effect of the CIT pilot on BPD officer attitudes regarding persons with mental illness and confidence managing behavioral health calls for service. Officer surveys and small group analyses found that Central District officers were more confident handling behavioral health calls for service than Eastern District officers post-pilot. More officers in the pilot district felt better prepared for behavioral health calls for service post-pilot than officers in the control district. Results indicate the CIT program is effective at improving officer confidence and attitude towards responding to behavioral health calls for service.
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Affiliation(s)
- Marisa D Booty
- Department of Health Policy and Management, Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for Gun Policy and Research, 624 North Broadway, Room 591, Baltimore, MD, 21205, USA.
| | - Rebecca G Williams
- Department of Health Policy and Management, Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cassandra K Crifasi
- Department of Health Policy and Management, Center for Gun Policy and Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Justice for George Floyd and a reckoning for global mental health. Glob Ment Health (Camb) 2020; 7:e22. [PMID: 32963794 PMCID: PMC7490771 DOI: 10.1017/gmh.2020.17] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
In the wake of George Floyd's killing by police in Minneapolis and the global response inspired by Black Lives Matter, it is time for the field of global mental health to reexamine how we have acknowledged and addressed racism in our institutions, our research, and our mental health services. In solidarity with street level responses, this is an important opportunity to understand and collaboratively respond to public demand for systemic change. To respond effectively, it is vital to (1) be aware of the colonial history that influences today's practices, and move forward with anti-colonial and anti-racist actions; (2) identify where and why diversity and representation are lacking in the global mental health workforce, then follow steps to combat these disparities; and (3) work with communities and institutions to end both police violence and structural violence.
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24
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Strassle CG. CIT in small municipalities: Officer-level outcomes. BEHAVIORAL SCIENCES & THE LAW 2019; 37:342-352. [PMID: 30746747 DOI: 10.1002/bsl.2395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/21/2018] [Accepted: 12/26/2018] [Indexed: 06/09/2023]
Abstract
Research on the Crisis Intervention Team (CIT) as a method to deal with mental illness in policing encounters has primarily focused on officers from large urban areas. The current study examined officer-level outcomes in a non-urban geographical setting using a pre/post-CIT training design. The sample included 46 police officers from seven departments that would be considered rural and 13 that would be classified as suburban. Officers completed scales to gauge change in mental illness attitudes at the beginning and end of their one-week CIT training. CIT training resulted in reductions in stigmatic attitudes with seven large effect sizes (ranging from η2 = .24 to .59) across the two measures. The findings from this research are a direct response to the call for greater diversity in the size of police settings in the CIT literature and serve to expand the empirical base for CIT in relation to officer-level outcomes.
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Affiliation(s)
- Carla G Strassle
- Department of Psychology, School of Behavioral Sciences and Education, York College of Pennsylvania, York, PA, 17403, USA
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25
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Kubiak S, Shamrova D, Comartin E. Enhancing knowledge of adolescent mental health among law enforcement: Implementing youth-focused crisis intervention team training. EVALUATION AND PROGRAM PLANNING 2019; 73:44-52. [PMID: 30508702 DOI: 10.1016/j.evalprogplan.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/15/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
This study explores the feasibility, acceptability, fidelity, and outcomes of a youth version of the Crisis Intervention Team training (CIT-Y). This intervention is designed to keep youth with a mental health problem out of the criminal/legal system by equipping police officers with developmentally appropriate information and techniques. Whereas much is known about the adult-focused CIT training, little is known about the youth-focused training. This preliminary investigation uses multiple methods (training observations, officer interviews, and pre/post-tests) to assesses the implementation of CIT-Y in two Midwest counties. Multiple 8-hour training sessions were offered in both counties with 127 officers participating and completing the pre/post measure. The findings of this study confirmed that CIT-Y training was feasible in these counties and acceptable to the officers who participated. Outcomes from the pre/post-tests show that 86% of officers positively changed their knowledge and attitudes regarding youth with mental health problems. Interviews revealed a positive impact on officers' reported behaviors. While this preliminary investigation of CIT-Y showed positive outcomes, recommendations for enhancing the curriculum and subsequent research are discussed.
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Affiliation(s)
- Sheryl Kubiak
- Wayne State University, School of Social Work, United States
| | - Daria Shamrova
- Wichita State University, School of Social Work, United States
| | - Erin Comartin
- Wayne State University, School of Social Work, United States.
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26
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Crisanti AS, Earheart JA, Rosenbaum NA, Tinney M, Duhigg DJ. Beyond crisis intervention team (CIT) classroom training: Videoconference continuing education for law enforcement. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:104-110. [PMID: 30616844 DOI: 10.1016/j.ijlp.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/23/2018] [Accepted: 12/06/2018] [Indexed: 06/09/2023]
Abstract
Continuing education in Crisis Intervention Team (CIT) principles and best practices are limited. In 2015, the Albuquerque Police Department became the first law enforcement agency in the country to provide extended learning for CIT and case debriefings related to behavioral health through videoconferencing technology. The project, known as CIT ECHO, connects law enforcement agencies across New Mexico and the country to an online classroom where CIT experts and psychiatrists review behavioral health topics, and debrief complex cases with officers. An overview of CIT ECHO is provided including key elements, implementation challenges, and how we are evaluating its reach and effectiveness.
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Affiliation(s)
- Annette S Crisanti
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, United States.
| | - Jennifer A Earheart
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, United States.
| | - Nils A Rosenbaum
- Behavioral Health Division, Albuquerque Police Department, United States.
| | - Matthew Tinney
- Crisis Intervention Unit, Albuquerque Police Department, United States.
| | - Daniel J Duhigg
- Behavioral Health Services, Presbyterian Healthcare Services, United States.
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27
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Bohrman C, Wilson AB, Watson A, Draine J. How Police Officers Assess for Mental Illnesses. VICTIMS & OFFENDERS 2018; 13:1077-1092. [PMID: 31447618 PMCID: PMC6707744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study examined how police officers assess for mental illnesses and how those assessments vary by location. Researchers conducted semi-structured interviews with 15 officers working in two police districts in one city. Findings from the study indicate that officers make assessments based on information from dispatch, collateral contacts and behavioral observations on the scene. The study also found that neighborhood context shaped the assessment process due to variations in types of information that were available to officers in different locations. The findings indicate that there is a need to improve the quality of all three sources of information.
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Affiliation(s)
- Casey Bohrman
- West Chester University, School of Education and Social Work
| | - Amy Blank Wilson
- University of North Carolina at Chapel Hill, School of Social Work
| | - Amy Watson
- University of Illinois at Chicago, Jane Addams College of Social Work
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28
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Holman G, O'Brien AJ, Thom K. Police and mental health responses to mental health crisis in the Waikato region of New Zealand. Int J Ment Health Nurs 2018; 27:1411-1419. [PMID: 29427304 DOI: 10.1111/inm.12440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 01/04/2023]
Abstract
New Zealand police report a high level of involvement with people in mental health crisis, something that has been reported in the international literature in recent decades. Involvement of police represents a coercive pathway to care and is likely to be associated with use of force. The aim of this study was to investigate the clinical, legal, and social characteristics of individuals subject to police response in the Waikato region of New Zealand. Data were also collected on characteristics of police response, including use of force, time of day, and disposition. Use of force, most commonly use of handcuffs, occurred in 78% of cases involving police. The study showed that Māori were overrepresented in police responses, but no more likely than Europeans to experience use of force. Almost half those subject to police response were not subsequently admitted to hospital, raising questions about the need for and nature of police response in these cases. Because mental health nurses are often part of police response, nurses need to take cognisance of their relationship with police and contribute to any initiatives that can reduce coercion in the pathway to care, and improve service users' experience in mental health crises.
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Affiliation(s)
- Graham Holman
- Waikato District Health Board, Hamilton, New Zealand
| | | | - Katey Thom
- University of Auckland, Auckland, New Zealand
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29
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Compton MT, Bakeman R, Broussard B, D'Orio B, Watson AC. Police officers' volunteering for (rather than being assigned to) Crisis Intervention Team (CIT) training: Evidence for a beneficial self-selection effect. BEHAVIORAL SCIENCES & THE LAW 2017; 35:470-479. [PMID: 28940465 PMCID: PMC5741493 DOI: 10.1002/bsl.2301] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/25/2017] [Accepted: 04/30/2017] [Indexed: 06/07/2023]
Abstract
Officers' volunteering for Crisis Intervention Team (CIT) training-rather than being assigned-is assumed to be an important, beneficial self-selection bias. This bias remains poorly characterized, though CIT officers are more likely to be female and to have had exposure to the mental health field. We determined whether or not self-selection is beneficial with regard to knowledge, attitudes, and skills, as well as level of force used (i.e., no or low force versus any form of physical force) and disposition of subjects, in actual encounters. We compared CIT-trained officers who had volunteered with those who had been assigned using data from two prior, linked studies that compared CIT-trained and non-CIT officers on knowledge, attitudes, and skills (251 CIT-trained officers; 68% had volunteered), as well as behaviors (517 actual encounters provided by 91 CIT-trained officers; 70% had volunteered). Of 28 scores on knowledge, attitudes, and skills compared, six were statistically significantly different (p < .01) and another eight were marginally significant (.01 < p < .05). Furthermore, although CIT officers who had volunteered were more likely to report use of some form of physical force as we had defined it (which included the use of handcuffs), when they did so they were more likely to refer to treatment services and less likely to make an arrest. These effects were apparent even when taking into account effects of gender, having had exposure to the mental health field, empathy, and other covariates. In conclusion, we found evidence for benefits of self-selection/volunteering that should be further characterized, as it appears to be associated with better outcomes with regard to key attitudes, skills, and behaviors.
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Affiliation(s)
- Michael T. Compton
- Correspondence to: Michael T. Compton, M.D., M.P.H., Columbia University College of Physicians & Surgeons, Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive Unit 100, New York NY 10032, Tel: 1+ (917) 340-8762, Fax: 1+ ,
| | - Roger Bakeman
- Georgia State University, Department of Psychology, Atlanta, GA
| | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY
| | - Barbara D'Orio
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA
| | - Amy C. Watson
- University of Illinois at Chicago, Jane Addams College of Social Work, Chicago, IL
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30
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Watson AC, Compton MT, Draine JN. The crisis intervention team (CIT) model: An evidence-based policing practice? BEHAVIORAL SCIENCES & THE LAW 2017; 35:431-441. [PMID: 28856706 DOI: 10.1002/bsl.2304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Abstract
As academic researchers, we are often asked to opine on whether the Crisis Intervention Team model (CIT) is an evidence-based practice (EBP) or evidence-based policing. Our answer is that it depends on how you define evidence-based practice and what outcome you are interested in. In this commentary, we briefly describe the CIT model, examine definitions of evidence-based practice and evidence-based policing, and then summarize the existing research on what is known about the effectiveness of CIT to date. We conclude that CIT can be designated an EBP for officer-level cognitive and attitudinal outcomes, but more research is needed to determine if CIT can be designated an EBP for other outcomes. Using an evidence-based practice process approach, CIT may also be a justified strategy for many communities. Future directions to inform the field are discussed.
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Affiliation(s)
- Amy C Watson
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael T Compton
- Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Jeffrey N Draine
- School of Social Work, College of Public Health Temple University, Philadelphia, Pennsylvania, USA
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Compton MT, Anderson S, Broussard B, Ellis S, Halpern B, Pauselli L, O'Neal M, Druss BG, Johnson M. A potential new form of jail diversion and reconnection to mental health services: II. Demonstration of feasibility. BEHAVIORAL SCIENCES & THE LAW 2017; 35:492-500. [PMID: 29098714 DOI: 10.1002/bsl.2319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/31/2017] [Accepted: 08/06/2017] [Indexed: 06/07/2023]
Abstract
Given fragmentation between mental health and criminal justice systems, we tested the feasibility of implementing a potential new form of pre-booking jail diversion. Our "linkage system" consists of three steps: (i) individuals with serious mental illnesses and an arrest history give special consent to be enrolled in a statewide database; (ii) if an officer has an encounter with an enrolled patient and runs a routine background check, he or she receives an electronic message to call; and (iii) the "linkage specialist" provides brief telephonic assistance to the officer. Of 206 eligible individuals, 199 (96.6%) opted in, the database received 679 hits, and the linkage specialist received 31 calls (and in at least three cases an arrest was probably averted). The mean number of arrests was 0.59 ± 0.92 in the year before enrollment (38.7% arrested) and 0.48 ± 0.83 during the 12-month intervention (30.7% arrested). Implementation is feasible, and a signal that the system might reduce incarceration was detected, encouraging development of a larger study.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, U.S.A
| | | | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, U.S.A
| | | | - Brooke Halpern
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, U.S.A
| | - Luca Pauselli
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, U.S.A
| | | | - Benjamin G Druss
- Rollins School of Public Health, Department of Health Policy and Management, Atlanta, GA, U.S.A
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Compton MT, Halpern B, Broussard B, Anderson S, Smith K, Ellis S, Griffin K, Pauselli L, Myers N. A potential new form of jail diversion and reconnection to mental health services: I. Stakeholders' views on acceptability. BEHAVIORAL SCIENCES & THE LAW 2017; 35:480-491. [PMID: 29098720 DOI: 10.1002/bsl.2320] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/31/2017] [Accepted: 09/07/2017] [Indexed: 06/07/2023]
Abstract
The most effective point of intervention to prevent unnecessary arrest/incarceration of persons with serious mental illnesses is the initial encounter with police. We piloted a new police-mental health linkage system. When officers run an enrolled participant's name/identifiers, they receive an electronic message that the person has mental health considerations and that they should call for information. The linkage specialist receives the call and assists telephonically. In this qualitative study to examine acceptability of the linkage system, we conducted nine focus groups with diverse stakeholders (e.g., enrolled patients, officers). Focus groups revealed that patients enrolled with the hope that the linkage system would prevent negative interactions with police and minimize risk of arrest. Officers reported preferring not to arrest mental health patients and were genuinely invested in helping them, and felt that the linkage system might be an additional tool during encounters. Findings revealed acceptability of the intervention, and further research is warranted.
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Affiliation(s)
- Michael T Compton
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | - Brooke Halpern
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA
| | - Beth Broussard
- Lenox Hill Hospital, Department of Psychiatry, New York, NY, USA
| | | | - Kelly Smith
- Gateway Behavioral Health Services, Savannah, GA, USA
| | | | - Kara Griffin
- Southern Methodist University, Department of Anthropology, Dallas, TX, USA
| | - Luca Pauselli
- Columbia University College of Physicians and Surgeons, Department of Psychiatry, New York, NY, USA
| | - Neely Myers
- Southern Methodist University, Department of Anthropology, Dallas, TX, USA
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Abreu D, Parker TW, Noether CD, Steadman HJ, Case B. Revising the paradigm for jail diversion for people with mental and substance use disorders: Intercept 0. BEHAVIORAL SCIENCES & THE LAW 2017; 35:380-395. [PMID: 29034504 DOI: 10.1002/bsl.2300] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/21/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
A conceptual model for community-based strategic planning to address the criminalization of adults with mental and substance use disorders, the Sequential Intercept Model has provided jurisdictions with a framework that overcomes traditional boundaries between the agencies within the criminal justice and behavioral health systems. This article presents a new paradigm, Intercept 0, for expanding the utility of the Sequential Intercept Model at the front end of the criminal justice system. Intercept 0 encompasses the early intervention points for people with mental and substance use disorders before they are placed under arrest by law enforcement. The addition of Intercept 0 creates a conceptual space that enables stakeholders from the mental health, substance use, and criminal justice systems to consider the full spectrum of real-world interactions experienced by people with mental and substance use disorders with regard to their trajectories, or lack thereof, through the criminal justice system.
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Affiliation(s)
- Dan Abreu
- Policy Research Associates, Inc., 345 Delaware Avenue, Delmar, NY, 12054, USA
| | - Travis W Parker
- Policy Research Associates, Inc., 345 Delaware Avenue, Delmar, NY, 12054, USA
| | - Chanson D Noether
- Policy Research Associates, Inc., 345 Delaware Avenue, Delmar, NY, 12054, USA
| | - Henry J Steadman
- Policy Research Associates, Inc., 345 Delaware Avenue, Delmar, NY, 12054, USA
| | - Brian Case
- Policy Research Associates, Inc., 345 Delaware Avenue, Delmar, NY, 12054, USA
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Bouveng O, Bengtsson FA, Carlborg A. First-year follow-up of the Psychiatric Emergency Response Team (PAM) in Stockholm County, Sweden: A descriptive study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2016.1264040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Olof Bouveng
- Department of Emergency Psychiatry, Norra Stockholms Psykiatri, Stockholm County Council, Stockholm, Sweden
| | - Fredrik A. Bengtsson
- Department of Emergency Psychiatry, Norra Stockholms Psykiatri, Stockholm County Council, Stockholm, Sweden
| | - Andreas Carlborg
- Department of Emergency Psychiatry, Norra Stockholms Psykiatri, Stockholm County Council, Stockholm, Sweden
- Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
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Wood JD, Watson AC. Improving police interventions during mental health-related encounters: Past, present and future. POLICING & SOCIETY 2016; 27:289-299. [PMID: 29200799 PMCID: PMC5705098 DOI: 10.1080/10439463.2016.1219734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There are calls across America for police to re-imagine themselves as "guardians" rather than "warriors" in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through improved knowledge and attitudes about mental health vulnerabilities and needs. Building on the progress made, we suggest there are critical opportunities for a new wave of efforts that can further advance the guardianship agenda. We highlight three such opportunities: (1) Enhancing experiences of procedural justice during mental health-related encounters; (2) Building the evidence base through integrated data sets; and (3) Balancing a "case-based" focus with a "place-based" focus.
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Affiliation(s)
- Jennifer D Wood
- Department of Criminal Justice and Centre for Security and Crime Science, Temple University, Philadelphia, P.A., USA
| | - Amy C Watson
- Jane Addams College of Social Work, University of Illinois at Chicago, Chicago, IL, USA
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Draper J, Murphy G, Vega E, Covington DW, McKeon R. Helping callers to the National Suicide Prevention Lifeline who are at imminent risk of suicide: the importance of active engagement, active rescue, and collaboration between crisis and emergency services. Suicide Life Threat Behav 2015; 45:261-70. [PMID: 25270689 PMCID: PMC4491352 DOI: 10.1111/sltb.12128] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/16/2014] [Indexed: 11/29/2022]
Abstract
In 2012, the SAMHSA-funded National Suicide Prevention Lifeline (Lifeline) completed implementation of the first national Policy for Helping Callers at Imminent Risk of Suicide across its network of crisis centers. The policy sought to: (1) provide a clear definition of imminent risk; (2) reflect the state of evidence, field experience, and promising practices related to reducing imminent risk through hotline interventions; and (3) provide a uniform policy and approach that could be applied across crisis center settings. The resulting policy established three essential principles: active engagement, active rescue, and collaboration between crisis and emergency services. A sample of the research and rationale that underpinned the development of this policy is provided here. In addition, policy implementation, challenges and successes, and implications for interventions to help Lifeline callers at imminent risk of suicide are detailed.
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Affiliation(s)
- John Draper
- National Suicide Prevention Lifeline, Link 2 Health Solutions, Inc.New York, NY, USA
| | - Gillian Murphy
- National Suicide Prevention Lifeline, Link 2 Health Solutions, Inc.New York, NY, USA
| | - Eduardo Vega
- Mental Health Association of San FranciscoSan Francisco, CA, USA,The Center for Dignity, Recovery and EmpowermentSan Francisco, CA, USA
| | | | - Richard McKeon
- Substance Abuse and Mental Health Services AdministrationRockville, MD, USA
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Kohrt BA, Blasingame E, Compton MT, Dakana SF, Dossen B, Lang F, Strode P, Cooper J. Adapting the Crisis Intervention Team (CIT) model of police-mental health collaboration in a low-income, post-conflict country: curriculum development in Liberia, West Africa. Am J Public Health 2015; 105:e73-80. [PMID: 25602903 DOI: 10.2105/ajph.2014.302394] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to develop a curriculum and collaboration model for law enforcement and mental health services in Liberia, West Africa. METHODS In 2013 we conducted key informant interviews with law enforcement officers, mental health clinicians, and mental health service users in Liberia, and facilitated a 3-day curriculum workshop. RESULTS Mental health service users reported prior violent interactions with officers. Officers and clinicians identified incarceration and lack of treatment of mental health service users as key problems, and they jointly drafted a curriculum based upon the Crisis Intervention Team (CIT) model adapted for Liberia. Officers' mental health knowledge improved from 64% to 82% on workshop assessments (t=5.52; P<.01). Clinicians' attitudes improved (t=2.42; P=.03). Six months after the workshop, 69% of clinicians reported improved engagement with law enforcement. Since the Ebola outbreak, law enforcement and clinicians have collaboratively addressed diverse public health needs. CONCLUSIONS Collaborations between law enforcement and mental health clinicians can benefit multiple areas of public health, as demonstrated by partnerships to improve responses during the Ebola epidemic. Future research should evaluate training implementation and outcomes including stigma reduction, referrals, and use of force.
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Affiliation(s)
- Brandon A Kohrt
- Brandon A. Kohrt is with the Department of Psychiatry and Behavioral Sciences, Duke Global Health Institute, Duke University, Durham, NC. Elise Blasingame is with The Carter Center Mental Health Program, Atlanta, GA. Michael T. Compton is with the Department of Psychiatry, Lenox Hill Hospital, New York, NY. Samuel F. Dakana is with the National Police Training Academy, Liberian National Police, Paynesville, Liberia. Benedict Dossen is with The Carter Center Mental Health Program, Monrovia, Liberia. Frank Lang is with the Moultrie Police Department, Moultrie, GA. Patricia Strode is with the National Alliance on Mental Illness, Georgia Affiliate, Atlanta. Janice Cooper is with The Carter Center Mental Health Program, Monrovia, Liberia
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