Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia

Putting a label on someone: impact of schizophrenia stigma on emotional mimicry, liking, and interpersonal closeness

Affiliation is both an antecedent and a consequence of emotional mimicry (i.e. imitating a counterpart's emotional expression). Thus, interacting with a disliked partner can decrease emotional mimicry, which in turn can further decrease liking. This perpetuating circle has not been investigated in the context of mental health stigma yet. The present study tested the influence of the label "schizophrenia" on liking, interpersonal closeness, and emotional mimicry. In an online experiment (n = 201), participants recruited from the general population saw several videos of actors displaying emotional expressions. Actors were described with one of four labels: "schizophrenia", "healthy", "diabetes", and a negative adjective (e.g. "hot-tempered"). Emotional mimicry was measured using OpenFace 2.2. Liking and interpersonal closeness were assessed with questionnaires. Overall, compared to other labels, participants reported less liking and interpersonal closeness to the actor with the schizophrenia label. However, no effect on emotional mimicry was found. The decreased liking of the schizophrenia actors was explained by a lack of knowledge about schizophrenia and the explicit stigma of schizophrenia. Our study contributes to the literature by highlighting the need to reduce the stigma of schizophrenia.

A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol

BACKGROUND

Stigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients.

METHODS

This paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up.

DISCUSSION

Stigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described.

TRIAL REGISTRATION

This clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register.

CLINICALTRIALS

gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx .

The association between exposure to community violence and somatic symptoms through bullying victimization among African American adolescents in Chicago: A developmental trauma approach

BACKGROUND

The developmental trauma theory suggests that traumatic events impede the ability of individuals to form interpersonal relationships, impair cognition, affect, and increase the vulnerability of adolescents to develop psychopathology. However, few studies have examined the applicability of this theory among African American adolescents who were exposed to community violence and adverse outcomes, including bullying victimization and somatic symptoms.

AIMS

Therefore, the purpose of the present study is to first test the association between exposure to community violence and somatic symptoms. Then, we explored whether bullying victimization mediated the relationship between exposure to community violence and somatic symptoms while controlling for gender differences and substance use (n = 622).

RESULTS

Results suggest that exposure to community violence is positively associated with somatic symptoms. Moreover, the association between exposure to community violence and somatic symptoms was mediated by bullying victimization.

DISCUSSION AND CONCLUSION

These results were consistent with the developmental trauma theory, such that trauma could increase the vulnerability for future victimization, thus, leading to somatic symptoms. Implications for research and practice are discussed.

Effects on Participant Knowledge, Situational Anxiety, and Social Distance Attitudes Following CIT Training

Crisis Intervention Teams (CIT) promote community collaboration to better assist people living with mental illness and/or drug addiction who are in crisis (Mission, n.d.). A core element of the CIT model is the 40 h training focused on increasing law enforcement officers' knowledge of behavioral health issues and use of de-escalation skills in crisis response (CIT International, n.d.). The purpose of this study was to examine the effectiveness of CIT training in a mid-size, Midwestern county on (1) participants' knowledge of mental illness and related concepts, (2) situational anxiety in crisis response, and (3) enhancing perceived comfort with people living with mental illness. This one-group pre-test/posttest study was conducted with four CIT training groups (n = 72) between 2017 and 2019. Findings indicate that participant knowledge and perceived comfort interacting with persons living with a mental illness were improved after the trainings, supporting use of CIT trainings in mid-size and rural communities.

Crisis Intervention Team (CIT) training and impact on mental illness and substance use-related stigma among law enforcement

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.

Using the Theory of Planned Behavior to Understand How Crisis Intervention Team (CIT) Training Facilitates Police Officers' Mental Health Referrals

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.

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

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.

Evaluation of Ongoing Crisis Intervention Team (CIT) Training for Law Enforcement Using the ECHO Model

Crisis Intervention Team (CIT) training aims to improve law enforcement officers' (LEOs) ability to safely intervene in calls for service involving individuals with mental illness, as well as to increase LEOs' ability to link these individuals to mental health services and divert them from the criminal justice system. However, most CIT training is delivered as a stand-alone class, and continuing education in CIT principles and best practices is limited. To address this problem, the Albuquerque Police Department, in partnership with the Department of Psychiatry and Behavioral Sciences at the University of New Mexico, developed CIT ECHO to provide continuing education in CIT best practices. The authors evaluated 113 weekly CIT ECHO sessions targeting LEOs in New Mexico, offered between 2017 and 2020. LEOs electronically completed a post-session survey after each didactic; additionally, a targeted follow-up survey was distributed to LEOs participating in at least three sessions. Surveys measured impact of CIT ECHO on knowledge, self-efficacy, and attitudes towards individuals with mental illness involved in the criminal justice system. After participating in CIT ECHO, LEOs reported increases in knowledge of didactic content and that they felt comfortable applying didactic content on the job. LEOs also evidenced positive attitudinal shifts towards individuals with mental illness and criminal justice involvement. Continuing education in CIT best practices appears to increase LEOs' knowledge base and comfort in working with individuals with mental illness and criminal justice involvement, as well as results in positive attitudinal shifts towards this population.

Mental illness-related stigma among probation officers

BACKGROUND

Probation officers tend to hold stigmatising attitudes towards individuals on their caseload with mental illnesses. This can result in poor outcomes for justice-involved people with mental illnesses. Though anti-stigma interventions in the general public and among other criminal-legal professionals hold promise, these interventions have not been tested among probation officers.

AIMS

To measure levels of stigma towards mental illnesses among probation officers before and after a brief online training related to mental illness.

METHODS

Two hundred and seventy-five probation and parole officers in one Midwest state completed a three-module online training programme designed to increase knowledge and skills for working with clients with mental illnesses. Officers completed a pre- and post-training assessment of level of stigmatising attitudes towards individuals with mental illnesses.

RESULTS

Officer levels of stigma statistically significantly decreased from pre-test (8.22) to post-test (7.37; p < 0.001, t = 6.13). Nevertheless, pre-training stigma scores were the strongest predictor of stigma levels at post-test (p < 0.001, b = 0.90).

CONCLUSIONS

While basic training can significantly decrease mental disorder stigmatising scores for probation officers, the practical effect of this brief online experience was very small. Nevertheless, the fact that such brief and generalised input can have impact at all is encouraging. Implementation could be a useful preliminary to improving the quality of probation supervision of clients with mental illnesses.

Police use of force standards and mental health crises in the United States: Identifying research and policymaking targets

An area of psychology-law research and policy that requires increased attention is the use of force during encounters with someone in mental health crisis. Cases in which law enforcement officer (LEO) intervention during a mental health crisis leads to injury or death of the person in crisis underscore the need to understand what behaviors and circumstances are relevant in excessive force litigation, what concepts may benefit from empirical research, and what facets of policies and precedent may require modification. In particular, the current national and international attention to the United States' external mechanisms of control over police conduct (i.e., criminal and civil proceedings against officers) suggests that excessive force jurisprudence is ripe for examination of its utility and fairness in shaping how police should interact with people with mental illness. Excessive force jurisprudence contains complex legal standards with which many psychology-law practitioners, researchers, and even policymakers are likely unfamiliar, however. The current paper explicates external methods of control over police conduct in the United States by reviewing excessive force jurisprudence and identifying points in need of research and policy attention.

Measuring disparities in police use of force and injury among persons with serious mental illness

OBJECTIVES

To measure disparities in experience of police use of force and injury among persons with serious mental illnesses.

METHODS

We gathered novel police use of force and suspect injury data from 2011 to 2017 from a nonrandom sample of nine police departments in the United States and used synthetic methods to estimate the share of the local population with serious mental illness. We estimate disparities using multi-level models estimated in a Bayesian framework.

RESULTS

Persons with serious mental illness constitute 17.0% of use of force cases (SD = 5.8) and 20.2% of suspects injured in police interaction (SD = 9.0) in sample cities. The risk that persons with serious mental illness will experience police use of force is 11.6 times higher (95% CI, 10.7-12.6) than persons without serious mental illness. Persons with serious mental illness are also at a higher risk of experiencing injury, 10.7 times (95% CI, 9.6-11.8), relative to persons without serious mental illness. These relative risk ratios are several times larger than racial and ethnic disparities estimated in the same cities.

CONCLUSION

Persons with serious mental are at a significantly elevated risk of experiencing police use of force and injury in police encounters than the general public. The disparities we estimate are several times higher than racial/ethnic disparities in force and injury. Efforts to reform police practices and reimagine public safety in the United States should address significant disparities in police use of force against those with serious mental illness.

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

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.

Developing an assessment tool for geropsychiatric mental healthcare knowledge and attitude evaluations in clinical practice for nursing students

AIM

To develop an instrument to investigate geropsychiatric psychological symptoms, health problem nursing knowledge (GPN-K), geropsychiatric psychological symptoms and health problem nursing attitude scale (GPN-A) in clinical practice for nursing students.

DESIGN

Instrument development and cross-sectional study for psychometric testing.

METHODS

Construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), and internal consistency was calculated using Cronbach's α.

RESULTS

A total of 300 students have completed the questionnaires (85.71% response rate). The CFA of GPN-K showed good fitness and validity. The Kuder-Richardson 20 (KR-20) value of the internal consistency reliability is 0.64. The GPN-A overall content validity index is 0.95. A three-factor structure was shown by exploratory factor analysis. The three factors are communication and care, helping others improve and problem evaluation tendency. The total variance explained is 59.01%. Cronbach's alpha of GPN-A equals 0.84, which represents good internal consistency.

CIT in small municipalities: Officer-level outcomes

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.

Enhancing knowledge of adolescent mental health among law enforcement: Implementing youth-focused crisis intervention team training

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.

Beyond crisis intervention team (CIT) classroom training: Videoconference continuing education for law enforcement

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.

The crisis intervention team (CIT) model: An evidence-based policing practice?

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.

Countywide implementation of crisis intervention teams: Multiple methods, measures and sustained outcomes

The crisis intervention team (CIT) is a tool that can be used to foster pre-booking diversion of individuals with mental illness from the criminal justice system and into community treatment services. Although CIT is often implemented solely as the training of law enforcement officers, the model stipulates that CIT is a vehicle for collaboration with community stakeholders who share a similar philosophy, as well as expanded mental health services offering a 24 hour-seven days per week drop-off option for law enforcement officers. This case study presents the countywide implementation of CIT and expands previous findings on the prevalence of officer interaction with persons with mental health issues and CIT training outcomes, including changes in officer perception of individuals with mental health issues. Furthermore, analysis of the disposition of calls for officer assistance coded as mental health or suicide found significant increases in officer drop-offs to the mental health crisis center post-CIT training. Interrupted time series analysis determined that this change has been sustained over time, perhaps owing to the unique communication between county law enforcement and mental health staff. Implications for policy and practice are discussed.

The effectiveness of interventions targeting the stigma of mental illness at the workplace: a systematic review

BACKGROUND

The majority of people experiencing mental-health problems do not seek help, and the stigma of mental illness is considered a major barrier to seeking appropriate treatment. More targeted interventions (e.g. at the workplace) seem to be a promising and necessary supplement to public campaigns, but little is known about their effectiveness. The aim of this systematic review is to provide an overview of the evidence on the effectiveness of interventions targeting the stigma of mental illness at the workplace.

METHODS

Sixteen studies were included after the literature review. The effectiveness of anti-stigma interventions at the workplace was assessed by examining changes in: (1) knowledge of mental disorders and their treatment and recognition of signs/symptoms of mental illness, (2) attitudes towards people with mental-health problems, and (3) supportive behavior.

RESULTS

The results indicate that anti-stigma interventions at the workplace can lead to improved employee knowledge and supportive behavior towards people with mental-health problems. The effects of interventions on employees' attitudes were mixed, but generally positive. The quality of evidence varied across studies.

CONCLUSIONS

This highlights the need for more rigorous, higher-quality evaluations conducted with more diverse samples of the working population. Future research should explore to what extent changes in employees' knowledge, attitudes, and supportive behavior lead to affected individuals seeking help earlier. Such investigations are likely to inform important stakeholders about the potential benefits of current workplace anti-stigma interventions and provide guidance for the development and implementation of effective future interventions.

Partnership

This study discusses the main barriers to partnership between family and health services in the context of schizophrenia and de-institutionalization (reduction of the length of hospitalization whenever possible and returning the patient to the community) addressed to deal with the increasing costs and demand for health care services. Thus, in de-institutionalization the burden of care is not resolved but shared with the family, under the assumption that the patient has someone—a family caregiver—who can take up the responsibility of care at home. Despite the high burden of care faced by the family caregiver in mental illness, the necessary systematic partnership between the medical team and the family caregiver is missing. Subjects were 47 family caregivers of persons living with schizophrenia. Data were collected using in-depth interviews, structured questionnaires and attitudinal scales. Data analysis included factor analysis and odds ratios. Two types of barriers to partnership are identified in the literature: health services barriers and barriers attributed to the family. The findings confirm the health services barriers but reject the assumed family barriers.

The Stigma Complex

Since the beginning of the twenty-first century, research on stigma has continued. Building on conceptual and empirical work, the recent period clarifies new types of stigmas, expansion of measures, identification of new directions, and increasingly complex levels. Standard beliefs have been challenged, the relationship between stigma research and public debates reconsidered, and new scientific foundations for policy and programs suggested. We begin with a summary of the most recent Annual Review articles on stigma, which reminded sociologists of conceptual tools, informed them of developments from academic neighbors, and claimed findings from the early period of "resurgence." Continued (even accelerated) progress has also revealed a central problem. Terms and measures are often used interchangeably, leading to confusion and decreasing accumulated knowledge. Drawing from this work but focusing on the past 14 years of stigma research (including mental illness, sexual orientation, HIV/AIDS, and race/ethnicity), we provide a theoretical architecture of concepts (e.g., prejudice, experienced/received discrimination), drawn together through a stigma process (i.e., stigmatization), based on four theoretical premises. Many characteristics of the mark (e.g., discredited, concealable) and variants (i.e., stigma types and targets) become the focus of increasingly specific and multidimensional definitions. Drawing from complex and systems science, we propose a stigma complex, a system of interrelated, heterogeneous parts bringing together insights across disciplines to provide a more realistic and complicated sense of the challenge facing research and change efforts. The Framework Integrating Normative Influences on Stigma (FINIS) offers a multilevel approach that can be tailored to stigmatized statuses. Finally, we outline challenges for the next phase of stigma research, with the goal of continuing scientific activity that enhances our understanding of stigma and builds the scientific foundation for efforts to reduce intolerance.

Do Crisis Intervention Teams Reduce Arrests and Improve Officer Safety? A Systematic Review and Meta-Analysis

Until the 1950s, state mental health hospitals accommodated the majority of individuals suffering from mental illness. Today, however, following the closing of state mental hospitals, persons with serious mental illness without adequate private care are 3 times more likely to be housed in a jail or prison than in a hospital. The consequences associated with increased contact between the criminal justice system and the mentally ill necessitates a comprehensive strategy that targets improvement in interaction between the criminal justice system and the mentally ill. This article reports on findings of a systematic review and meta-analysis of the Crisis Intervention Team (CIT), a widely adopted program implemented in police departments, in an effort to reduce reliance on incarceration as mental health institutions, and to train officers about mental illness. The findings of this review and meta-analysis reveal null effects of CITs on arrests of persons with mental illness ( d = 0.180, p = .495) and on police officer safety ( d = −0.301, p = .191). These results do not suggest that CIT programs should be discontinued. However, potential improvements to program implementation and evaluation are discussed.

A Criminal Justice System–Wide Response to Mental Illness

The present study sought to evaluate the effectiveness of the Memphis Crisis Intervention Team (CIT) training curriculum among law enforcement and correctional officers. A panel research design was used in which a sample of 179 law enforcement officers and 100 correctional officers in nine Florida counties were surveyed on the first day of training (pretest), the last day of training (posttest), and 1 month following their completion of CIT training (follow-up). These surveys measured the extent to which CIT training achieved several officer-level objectives, including increased knowledge of mental illness, improved self-efficacy when responding to mental health crises, and enhanced perceptions of verbal de-escalation skills. The results of these surveys revealed that the training effectively achieved these objectives in the short term, but a measurable decay was found in the follow-up time frame with regard to self-efficacy and perceptions of verbal de-escalation.

Causal attribution of mental illness in South-Eastern Nigeria

BACKGROUND

Understanding of mental illness in sub-Saharan Africa has remained under-researched in spite of the high and increasing neuropsychiatric burden of disease in the region.

AIMS

This study investigated the causal beliefs that the Igbo people of south-eastern Nigeria hold about schizophrenia, with a view to establishing the extent to which the population makes psychosocial, biological and supernatural attributions.

METHOD

Multi-stage sampling was used to select participants (N = 200) to which questionnaires were administered.

RESULTS

Mean comparison of the three causal models revealed a significant endorsement of supernatural causation. Logistic regressions revealed significant contributions of old age and female gender to supernatural attribution; old age, high education and Catholic religious denomination to psychosocial attributions; and high education to biological attributions.

CONCLUSIONS

It is hoped that the findings would enlighten, augment literature and enhance mental health care service delivery.

The police-based crisis intervention team (CIT) model: I. Effects on officers' knowledge, attitudes, and skills

OBJECTIVE

Individuals with serious mental illnesses are very likely to interact with police officers. The crisis intervention team (CIT) model is being widely implemented by police departments across the United States to improve officers' responses. However, little research exists on officer-level outcomes. The authors compared officers with or without CIT training on six key constructs related to the CIT model: knowledge about mental illnesses, attitudes about serious mental illnesses and treatments, self-efficacy for deescalating crisis situations and making referrals to mental health services, stigmatizing attitudes, deescalation skills, and referral decisions.

METHODS

The sample included 586 officers, 251 of whom had received the 40-hour CIT training (median of 22 months before the study), from six police departments in Georgia. In-depth, in-person assessments of officers' knowledge, attitudes, and skills were administered. Many measures were linked to two vignettes, in written and video formats, depicting typical police encounters with individuals with psychosis or with suicidality.

RESULTS

CIT-trained officers had consistently better scores on knowledge, diverse attitudes about mental illnesses and their treatments, self-efficacy for interacting with someone with psychosis or suicidality, social distance stigma, deescalation skills, and referral decisions. Effect sizes for some measures, including deescalation skills and referral decisions pertaining to psychosis, were substantial (d=.71 and .57, respectively, p<.001).

CONCLUSIONS

CIT training of police officers resulted in sizable and persisting improvements in diverse aspects of knowledge, attitudes, and skills. Research should now address potential outcomes at the system level and for individuals with whom officers interact.

A Novel Training Program for Police Officers that Improves Interactions with Mentally Ill Individuals and is Cost-Effective

Police and law enforcement providers frequently come into contact with individuals who have psychiatric disorders, sometimes with tragic results. Repeated studies suggest that greater understanding of psychiatric conditions by police officers would be beneficial. Here we present a novel approach to training police officers to improve their interactions with those who might have a mental illness. This approach involved developing a carefully scripted role-play training, which involved police officers (n = 663) interacting with highly trained actors during six realistic scenarios. The primary goal of the training was to improve empathy, communication skills, and the ability of officers to de-escalate potentially difficult situations. Uniquely, feedback was given to officers after each scenario by several individuals including experienced police officers, a mental health professional, and by the actors involved (with insights such as "this is how you made me feel"). Results showed that there were no changes in attitudes of the police toward the mentally ill comparing data at baseline and at 6 months after the training in those who completed both ratings (n = 170). In contrast, there were significant improvements in directly measured behaviors (n = 142) as well as in indirect measurements of behavior throughout the police force. Thus, compared to previous years, there was a significant increase in the recognition of mental health issues as a reason for a call (40%), improved efficiency in dealing with mental health issues, and a decrease in weapon or physical interactions with mentally ill individuals. The training cost was $120 per officer but led to significant cost savings (more than $80,000) in the following 6 months. In conclusion, this novel 1-day training course significantly changed behavior of police officers in meaningful ways and also led to cost savings. We propose that this training model could be adopted by other police agencies.

Intervening at the entry point: differences in how CIT trained and non-CIT trained officers describe responding to mental health-related calls

In response to challenges officers face with mental health-related calls, police departments are implementing specialized response programs like Crisis Intervention Teams (CIT). CIT is gaining support for its promise to promote safe, respectful interactions with police and individuals with mental illnesses. This paper outlines the results of a qualitative study investigating the impact of CIT. We found difference in CIT and non-CIT officers' response tactics to mental health-related calls and assessments of danger. CIT officers described a broader understanding of exhibited behaviors and considered more options when deciding the outcomes of calls. Implications and directions for future research are discussed.

Development and initial reliability and validity of four self-report measures used in research on interactions between police officers and individuals with mental illnesses

There currently exists a dearth of reliable and valid instruments to examine key police officer variables of importance in the growing research on their interactions with individuals with mental illnesses. This study tested reliability and validity of four newly designed measures of the constructs of self-efficacy (Self-Efficacy Scale; SES), referral decisions and de-escalation skills (Behavioral Outcomes Scale; BOS), attitudes toward psychiatric treatment (Opinions about Psychiatric Treatment; OPT), and social distance (Adapted Social Distance Scale; ASDS) in a sample of law enforcement officers. Self-administered, anonymous surveys, which included the measures of interest, were completed by 177 officers-68 of whom were undergoing Crisis Intervention Team (CIT) training and 109 of whom were not-at the beginning and end of week-long trainings. Analyses examined the internal consistency reliability, test-retest reliability, and construct validity of the instruments. The four measures of interest were found to be reliable and valid. Specifically, internal consistency coefficients and test-retest reliability correlations were generally acceptable, all four demonstrated sensitivity to change, and validity correlations were significant and in the expected direction. Findings demonstrated the ability to measure key constructs related to attitudes and intended behaviors in law enforcement officers utilizing psychometrically sound instruments. Further testing and the development of additional reliable and valid instruments focused on attitudinal and behavioral domains among officers who have frequent interactions with individuals with mental illnesses would be of great value.

Development, item analysis, and initial reliability and validity of a multiple-choice knowledge of mental illnesses test for lay samples

The public's level of mental health literacy remains low, despite growing access to information regarding mental illnesses. Because few measures exist to assess the level of knowledge of mental illnesses in lay samples, the Multiple-Choice Knowledge of Mental Illnesses Test (MC-KOMIT) was developed, initially for use in a study involving police officers, some of whom received 40 h of training focused on recognizing mental illnesses, using verbal de-escalation techniques, and making mental health referrals when appropriate. This report details the initial development of the 100 questions in the item bank and the eventual selection of the final 33 items that were retained. For these 33 items, internal consistency was demonstrated, and test-retest reliability was examined among officers not in the mental health-related training who completed the test on Monday morning and again on Friday afternoon. Construct validity was examined by three hypothesis tests: the MC-KOMIT was sensitive to change related to the educational intervention, scores were significantly correlated with years of educational attainment, and officers reporting past or current treatment for a mental health problem scored higher than those without such a history. This initial report suggests that the MC-KOMIT may be useful in quantifying knowledge of mental illnesses in police officers and other diverse lay samples.

Do empathy and psychological mindedness affect police officers' decision to enter crisis intervention team training?

OBJECTIVE

Police officers' voluntary choice to participate in specialized, week-long crisis intervention team (CIT) training is generally assumed to be a critical factor in success as a CIT officer. However, issues about self-selection have not been empirically examined. The investigators hypothesized that officers entering CIT training, especially those electing to take it, would have a higher likelihood of exposure to and experience with mental health issues and mental health professionals and greater empathy and psychological mindedness.

METHODS

A total of 177 officers-including 109 non-CIT-trained officers, 24 officers assigned to CIT training, and 44 officers who volunteered for CIT training-were assessed before and after their week-long classes (non-CIT officers were enrolled in other courses). Basic sociodemographic characteristics were assessed, and four psychometrically sound measures of empathy and psychological mindedness were administered. Associations between officer status and sociodemographic variables, past exposure to and experience with mental illness issues, and empathy and psychological mindedness were examined.

RESULTS

The three groups did not differ on three of four exposure and experience variables; however, self-selected CIT officers were more likely to have prior exposure to mental health issues and professionals. No differences were found between the three groups on measures of empathy or psychological mindedness. One measure of empathy increased significantly after the weeklong CIT training.

CONCLUSIONS

Findings did not support the hypothesis that officers self-selecting into CIT training would have greater baseline empathy and psychological mindedness. Although there may be other justifiable reasons to argue for the importance of volunteering, these two traits did not appear to be greater among officers self-selecting into CIT.

Do empathy and psychological mindedness affect police officers' decision to enter crisis intervention team training?

OBJECTIVE

Police officers' voluntary choice to participate in specialized, week-long crisis intervention team (CIT) training is generally assumed to be a critical factor in success as a CIT officer. However, issues about self-selection have not been empirically examined. The investigators hypothesized that officers entering CIT training, especially those electing to take it, would have a higher likelihood of exposure to and experience with mental health issues and mental health professionals and greater empathy and psychological mindedness.

METHODS

A total of 177 officers-including 109 non-CIT-trained officers, 24 officers assigned to CIT training, and 44 officers who volunteered for CIT training-were assessed before and after their week-long classes (non-CIT officers were enrolled in other courses). Basic sociodemographic characteristics were assessed, and four psychometrically sound measures of empathy and psychological mindedness were administered. Associations between officer status and sociodemographic variables, past exposure to and experience with mental illness issues, and empathy and psychological mindedness were examined.

RESULTS

The three groups did not differ on three of four exposure and experience variables; however, self-selected CIT officers were more likely to have prior exposure to mental health issues and professionals. No differences were found between the three groups on measures of empathy or psychological mindedness. One measure of empathy increased significantly after the weeklong CIT training.

CONCLUSIONS

Findings did not support the hypothesis that officers self-selecting into CIT training would have greater baseline empathy and psychological mindedness. Although there may be other justifiable reasons to argue for the importance of volunteering, these two traits did not appear to be greater among officers self-selecting into CIT.

Effect of an education program on improving knowledge of schizophrenia among parents of junior and senior high school students in Japan

BACKGROUND

Early detection and intervention in schizophrenia are important in improving quality of life after treatment and are major issues in psychiatric care. Therefore, it is necessary to increase knowledge of schizophrenia among the general public. Among parents of junior and senior high school students in Japan, we compared rates of correct answers for items on knowledge of schizophrenia and ability to discriminate this psychosis from other disorders on questionnaires given before and after viewing a web-based education program.

METHODS

Questionnaires were distributed to 2,690 parents. The program was developed to help parents obtain a basic understanding of schizophrenia and to emphasize the necessity of early detection.

RESULTS

Before the program, the rate of correct answers was 77% for items concerning basic knowledge of schizophrenia, 47% for "discrimination of schizophrenia symptoms," and 30% for "discrimination of prodromal symptoms." The program resulted in an improvement in basic knowledge of schizophrenia, discrimination of schizophrenia symptoms, and discrimination of prodromal symptoms (P < 0.001 for all).

CONCLUSIONS

Our web-based education program was useful in helping parents acquire a basic knowledge of schizophrenia and discriminate correctly the symptoms of schizophrenia.

Including School Resource Officers in school-based crisis intervention: Strengthening student support

This article discusses the importance of trained police officers, School Resource Officers (SROs), participating in school-based crisis response efforts. These efforts, mostly preventative in nature, mitigate and de-escalate trauma for students exposed to a wide variety of challenging situations. Scenarios are presented with dialogue between students and SRO, offering insights into how SROs support students’ emotional needs. The article demonstrates how trained SROs’ service complements school-based crisis prevention and intervention efforts.

Mental illness stigma reduction interventions: review of intervention trials

This article reviews the literature evaluating the effectiveness of various stigma reduction interventions related to mental health illnesses. An integrated search of the English language literature from 1998 to May 2008 was done using CINAHL, Medline, PubMed, Scopus, and PsychINFO databases. The results of this review emphasize that experimental clinical trials hold promise for providing evidence-based data that can be used in mental health practice. Educational and contact-based strategies used in various stigma reduction programs resulted in the most durable gains in knowledge as well as positive attitudinal and behavioral changes needed to decrease the stigma associated with mental illness. Special stigma reduction programs are to be planned for adolescent and elderly targets. Future studies have yet to be designed to identify cost-effective stigma reduction programs. Moreover, interventional studies from different cultures are encouraged. Cross-cultural interventions need to be evaluated and modified to ensure providing culturally relevant interventions.

Characteristics of patients referred to psychiatric emergency services by crisis intervention team police officers

The Crisis Intervention Team (CIT) program trains police officers in crisis intervention skills and local psychiatric resources. Because the safety and appropriateness of any new intervention is a crucial consideration, it is necessary to ensure that CIT training does not result in excessive or inappropriate referrals to psychiatric emergency services (PES). Yet, aside from one prior report by Strauss et al. (2005) in Louisville, Kentucky, little is known about the comparability of patients referred to PES by CIT-trained officers in relation to other modes of referral. The research questions driving this retrospective chart review of patients referred to PES were: (1) What types of patients do CIT-trained officers refer to PES?, and (2) Do meaningful differences exist between patients referred by family members, non-CIT officers, and CIT-trained officers? Select sociodemographic and clinical variables were abstracted from the medical records of 300 patients during an eight-month period and compared by mode of referral. Differences across the three groups were found regarding: race, whether or not the patient was held on the locked observation unit, severe agitation, recent substance abuse, global functioning, and unkempt or bizarre appearance. However, there were virtually no differences between patients referred by CIT-trained and non-CIT officers. Thus, while there were some expected differences between patients referred by law enforcement and those referred by family members, CIT-trained officers appear to refer individuals appropriately to PES, as evidenced by such patients differing little from those referred by traditional, non-CIT police officers. Trained officers do not have a narrower view of people in need of emergency services (i.e., bringing in more severely ill individuals), and they do not have a broader view (i.e., bringing in those not in need of emergency services). Although CIT training does not appear to affect the type of individuals referred to PES, future research should examine the effect of CIT training on the frequency of referrals or proportion of subjects encountered that are referred, which may be expected to differ between CIT-trained and non-CIT officers.

Crisis Intervention Teams in Chicago: Successes on the Ground

Police officers encounter a sizable number of calls involving individuals who have mental illness. In response to the challenges that officers face with mental health calls, police departments nationally are implementing specialized response programs. In this paper, we present findings from qualitative interviews with police regarding the implementation of a well-known specialized response model, Crisis Intervention Teams. Researchers employed a grounded dimensional analysis to examine how CIT is utilized in four Chicago police districts. Results indicate that police, irrespective of whether they received CIT training, perceive an array of benefits of CIT implementation in their district. Implications for practice and policy are discussed.

System- and Policy-Level Challenges to Full Implementation of the Crisis Intervention Team (CIT) Model

The Crisis Intervention Team (CIT) model of collaboration between law enforcement and mental health is widely recognized as being "more than just training" for police officers; the core elements of CIT include a number of other components. However, several system- and policy-level obstacles can make successful implementation of CIT difficult in many communities. Three such challenges are addressed in this article: insufficient training and policies for dispatchers, poor availability of psychiatric emergency receiving facilities, and complexities related to implementation of CIT in rural settings. Collaboratively addressing these and other challenges will undoubtedly advance the goals of CIT.

Police Encounters, Mental Illness and Injury: An Exploratory Investigation

Police encounters are believed to be particularly dangerous for people with mental illness and police officers. Despite widespread concern among advocates, researchers and police professionals, little is known about the details of these interactions including the occurrence of injuries. In the current study, we explore injuries to people with mental illness and officers to determine the extent to which situational and individual factors predict injuries. Findings suggest that injuries during police calls involving persons with mental illness are infrequent and rarely require medical attention. Predictors of injuries in these calls are similar to those in police encounters with the general population.

Beliefs about causes of schizophrenia among police officers before and after crisis intervention team training

This study examined the ways in which beliefs about the causes of schizophrenia change after crisis intervention team (CIT) training of police officers. Comparisons of pre- and post-training scores from 159 officers revealed a decrease in endorsement of items pertaining to personal/family/social stressors and items inconsistent with contemporary conceptions of risk, as well as an increase in endorsement of items consistent with modern biological conceptions of the causation of schizophrenia. Changes in causal beliefs were associated with personal and family history of psychiatric treatment among officers. Findings indicate a need for further research in this area, and suggest that some characteristics of officers may be associated with an increased capacity for knowledge/attitudinal change during CIT training.

Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities

Introduction

In light of overwhelming evidence that access to sterile injection equipment reduces incidence of injection-attributable bloodborne disease without encouraging drug use, many localities have authorized sterile syringe access programs (SAPs), including syringe exchange and pharmacy-based initiatives. Even where such interventions are clearly legal, many law enforcement officers are unaware of the public health benefits and legal status of these programs and may continue to treat the possession of injection equipment as illegal and program participation as a marker of illegal behavior. Law enforcement practice can impede SAP utilization and may increase the risk of needlestick injury (NSI) among law enforcement personnel. Many SAPs conduct little or no outreach to law enforcement, in part because they perceive law enforcement actors as unreceptive to health-promotion programs targeting drug users.

Case description

We report on a brief training intervention for law enforcement personnel designed to increase officer knowledge of and positive attitudes towards SAPs by bundling content that addresses officer concerns about infectious disease and occupational safety with information about the legality and public health benefits of these programs. Pilot trainings using this bundled curriculum were conducted with approximately 600 officers in three US cities.

Discussion and evaluation

Law enforcement officers were generally receptive to receiving information about SAPs through the bundled curriculum. The trainings led to better communication and collaboration between SAP and law enforcement personnel, providing a valuable platform for better harmonization of law enforcement and public health activities targeting injection drug users.

Conclusion

The experience in these three cities suggests that a harm reduction training curriculum that bundles strategies for increasing officer occupational safety with information about the legality and public health benefits of SAPs can be well received by law enforcement personnel and can lead to better communication and collaboration between law enforcement and harm reduction actors. Further study is indicated to assess whether such a bundled curriculum is effective in changing officer attitudes and beliefs and reducing health risks to officers and injection drug users, as well as broader benefits to the community at large.

Desire for social distance from people with mental disorders

The scientific literature on stigma has been confused because there are multiple components of stigma with different correlates. In order to make sense of this confusion, the present review focuses on research on the most commonly measured component: social distance. The review examines measurement of social distance; characteristics of people who desire greater social distance; experiences that affect social distance; characteristics of people that elicit social distance; the effects of psychiatric labelling; the effects of causal explanations for mental disorders; and interventions to reduce social distance. It is concluded that future research on social distance needs to focus on better evaluation of interventions and examine discriminatory and supportive behaviours in real life rather than in hypothetical situations.

Incorporating Crisis Intervention Team (CIT) knowledge and skills into the daily work of police officers: a focus group study

This qualitative focus group study was conducted to evaluate the effectiveness of Crisis Intervention Team (CIT) training for police officers. Thematic analysis of transcripts of focus group discussions revealed that officers report increased knowledge of mental illnesses (which manifests as an improved ability to recognize and respond, reduced stereotyping/stigmatization, greater empathy toward consumers and their caregivers, more patience when dealing with consumers, and fewer arrests/more redirection toward treatment), as well as practical application of learned skills (evidenced by an ability to put individuals with mental illnesses at ease, reduced unpredictability of the crisis situation, and reduced risk of injury). Results highlight the potential for collaboration between law enforcement (and other public safety/criminal justice professions) and the mental health professions in the expanding CIT collaborative model.