Crisis Intervention Teams (CITs)

Background of the Crisis Intervention Team (CIT) model:

In September 1987, police officers in Memphis, Tennessee, were called to respond to an incident involving a young man with mental illness who was threatening suicide and cutting himself with a knife. When officers arrived at the scene and ordered the man to put the knife down, he refused and became more upset, running towards the officers with the knife still in his hand. The officers discharged their firearms, shooting and killing the man. Further, this incident had occurred during a time of racial tension in Memphis; the police officers were white while the young man was black, prompting increased outrage and protest by citizens against the officers.1

The Mayor of Memphis responded by turning to a community-based and collaborative approach to address the way in which officers responded to incidents involving individuals with mental illness. The Memphis Police Department joined in partnership with the Memphis Chapter of the National Alliance for the Mentally Ill (NAMI), along with mental health providers and two local universities (the University of Memphis and the University of Tennessee), to organize, train, and implement a specialized police unit. From this initial task force, the Memphis Police Department Crisis Intervention Team (CIT) emerged.2 Today, this original CIT is commonly known as the Memphis model and serves as a highly esteemed example for other police departments.

What is CIT?

The original Memphis Model of CIT aimed to create a team of police officers selected for specialized training in basic crisis intervention. Police officers should be handpicked for this training based on factors such as emotional IQ, number of use of force incidences, and number of complaints.3 These officers should be spread through the city on all shifts, not only performing usual duties of police officers but also being available for immediate dispatch to mental health crisis scenes. Upon arriving at the scene without delay, CIT officers should be able to de-escalate the crisis and, with the assistance of other police officers, assess the individual in crisis and “make the decision whether or not to transport a patient for further evaluation.” The receiving facility of this individual would “offer a single point of entry with referrals to resources such as community mental health services, social services, and Veteran’s services.”4

In more general terms, the CIT model overall attempts to improve safety for everyone involved in a police encounter and, when appropriate, divert individuals with mental illness from the criminal justice system or jail to mental health treatment facilities.5

The model centers on 40 hours of specialized mental health training for a select group of police officers who volunteer to become CIT officers. This training is provided by mental health clinicians, family members of individuals with mental illness, community advocates, and police trainers, and involves information on signs and symptoms of mental illnesses, mental health treatment, co-occurring disorders, legal issues, and verbal de-escalation techniques.6 This information is “presented in didactic, experiential and practical skills/scenario-based training formats,”7 and training may include interactions with individuals with mental illness, visits to mental health facilities, or a ride along with current CIT officers. Find the CIT resources section below to see examples of real CIT curriculum and training materials.

The CIT model, being a collaborative approach, aims to involve several people from different departments or positions who each have individual roles to create a wholistic, community-based approach to a safer police system. Thus, besides officers themselves, CIT programs incorporate several other positions:

Dispatchers: police dispatchers receive specialized training similar to that received by CIT officers. Dispatchers also receive “particularized instruction that addresses the proper method for receiving and dispatching officers to calls involving individuals with mental illness.”8 This training and instruction are used by dispatchers to complete their role of first identifying calls to police departments that may involve someone with a mental condition, and then relaying these calls to a CIT officer who can respond to the scene.
- The murder of Quintonio LeGrier in 2015 demonstrates the importance of incorporating trained police dispatchers into CIT programs. Quintonio, a 19-year-old student at Northern Illinois University, was home for winter break in December, 2015. He had a recent history of mental health problems and was “behaving erratically” when he called the police at 4.18 A.M., stating “I need an officer…” When Quintonio was unable or unwilling to provide more information to the dispatcher, the dispatcher ended the call even after Quintonio repeated “[t]here’s an emergency” upon the dispatcher telling him “if you can’t answer the questions, I’m going to hang up.” When a police officer arrived at the scene, Quintonio swung a bat at the officer a few times, prompting the officer to open fire and fire eight shots at Quintonio, killing him. (A stray bullet also passed through his apartment wall and killed his 55-year-old neighbor, Bettie Jones).9 A well-trained dispatcher who was familiar with sings of mental illness would have been more likely to recognize some of Quintonio’s symptoms and thus take appropriate measures such as dispatching a CIT-trained officer. Although departments may have CIT officers, these officers won’t be effectively relayed to a scene without a dispatcher first identifying the necessity for them.
Mental health coordinators: members of the local mental health community who “act as the liaison between the mental health and law enforcement communities.”10
Advocacy community: an advocacy community is comprised of mental health advocates and individuals with mental health conditions along with their family members. An advocacy coordinator acts as the representative of this group and is responsible for “operational components that include training, curriculum, and ongoing problem-solving.”11
Mental health facility: a designated emergency facility that treats mental health conditions and receives patients from a crises/call, serving as a point of emergency entry and providing an alternative to jail for individuals with mental illness.12

Since the development of the CIT model in the late 1980s in Memphis, CIT training programs have been implemented by more than 2,000 police departments across more than 40 states. Of the 3,142 counties in the United States, at least 26% have established CIT training programs.13

Benefits of CIT:

While there has not been enough research to date to declare CIT an “Evidence-Based Practice,” it has been called both a “Promising Practice” and “Best Practice model for Law Enforcement.”14 Here are some benefits of CIT that have been seen in several departments:

Improves safety for both officers and individuals with mental illness:

A 2000 (12 years after the development of the Memphis Model) study by Dupont and Cochran demonstrated an association between CIT implementation in Memphis and “decreased use of high-intensity police units such as Special Weapons and Tactics (SWAT) teams.”15
A 2005 study by the Connecticut Alliance to Benefit Law Enforcement found that the Memphis CIT training resulted in a 40% decline/reduction in the use of deadly force and injuries for the mentally ill, and an 85% decline in officer injuries during mental health crisis calls.16
Skeem and Bibeau’s 2008 study found that CIT officers only used force in 15% of encounters rated as high violence risk. Further, when they did use force, they relied more on low-lethality methods.17
Another study supported these results, finding that “CIT trained officers were less likely to resort to use of force than non-CIT officers.”18
In a qualitative study in 2008 by Hanafi, Bahora, Demir, and Compton, officers reported that application of their CIT skills “reduces the risk of injury to officers and persons with mental illness.”19
A study of Chicago’s CIT program by Morabito, Kerr, Watson, Draine, and Angell in 2012 found that CIT officers use less force in response to increase in subject resistance than officers who are not CIT trained.20
In the year following CIT program implementation, the San Jose (California) Police Department’s CIT program reported a 32% decrease in officer injuries.21
In the 3 years before implementing a CIT program, the rate of injuries to officers in the Memphis Police Department responding to “mental health disturbance calls” was 0.0035%, or one in 28,571 events. In the 3 years following CIT program implementation, this rate decreased to 0.0007%, or one in 142,857 events). Since other types of disturbance calls such as domestic violence calls did not similarly decrease in this time period22, it demonstrates that the CIT program was the cause of the decreased rate of officer injuries in response to mental health calls.
A study found that CIT exposure has a “statistically significant impact on the incidence of fatal shootings of unarmed persons in mental health crisis.”23

Improves officer knowledge and attitude regarding mental illness:

Borum, Deane, Steadman, and Morrissey’s 1998 study found that CIT training improves officers’ confidence in their departments’ response to mental health-related calls.24
A 2006 study by Compton et al. found that CIT training is associated with “improvements in attitudes and knowledge about mental illness.”25
A 2006 study by Wells and Schafer found that CIT training has been shown to improve “officers’ confidence in identifying and responding to persons with mental illness.”26
Additional research has shown a reduction in “officer bias” towards individuals with mental health disabilities after CIT training.27
A study found that officers in departments with CIT programs were more likely to indicate that they were well prepared in situations involving individuals with mental illness.28
A study found that CIT training for law enforcement officers reduces “stigmatizing attitudes” toward people with schizophrenia.29

Increases access to mental health services:

Initial reports from Memphis following their implementation of a CIT program demonstrate that the program increased safety and diversion to mental health services.30
A 2000 study by Steadman, Dean, Borum, and Morissey demonstrated an increase among CIT officers in transports to the hospital for psychiatric evaluation, along with an increase in the proportion of transports that are voluntary.31
A study found that CIT officers in Chicago were more likely to direct persons with mental illnesses to mental health treatment than their non-CIT colleagues.32
A study in the Akron (Ohio) Police Department comparing the outcomes of calls handled by CIT trained officers with those handled by non-CIT trained officers found that “CIT-trained officers transported people with mental illnesses to psychiatric emergency services significantly more often than their non-CIT trained counterparts.”33
The Memphis Police Department’s CIT program reported that in its first four years, the rate of referrals to the regional psychiatric emergency service by law enforcement officers increased by 42%.34
An analysis across 3 cities comparing responders in a CIT program, a co-responder program, and a mobile crisis team found that officers in a police-based response were more likely to transport individuals to mental health services and to resolve fewer incidents informally than other officers.35
A 4-site study comparing outcomes for individuals diverted by police with those for individuals not diverted by police found that diverted individuals had greater access to mental health crisis services. Among diverted individuals, 31.6% used emergency room (ER) services and 35.6% used hospital services, while among non-diverted individuals, 25.7% used ER services and 20.6% used hospital services. Additionally, diverted individuals had greater access to non-crisis services: of the diverted group, 81.6% received medication and 57.5% received counseling, while of the non-diverted group, 72.7% received medication and 55.3% received counseling.36

Decreases encounters between individuals with mental illness and criminal justice system:

Initial reports from Memphis following their implementation of a CIT program demonstrate that the program reduced arrests.37
However, a study in the Akron (Ohio) Police Department comparing outcomes of calls handled by CIT-trained officers with those handled by non-CIT officers supported a contrasting idea, finding no significant difference in the number of arrests between the two groups.38
A 2000 study by Steadman, Dean, Borum, and Morissey supported an association between CIT and lower arrest rates of persons with mental illnesses, and an increase in the number of mental health calls identified.39
In Chicago, CIT officers were less likely to resolve mental health calls with contact only than their non-CIT colleagues.40
An article summarizing studies of one-year outcomes of pre and post-arrest diversion programs found that diverted individuals with mental illnesses spent more time in the community without a related increase in arrests. This demonstrates that individuals referred to mental health treatment by law enforcement officers experience fewer subsequent contacts with the criminal justice system than individuals who were not referred.41
A study examined two specialized police-based programs – the CIT model and the co-responder model – in two police departments in Memphis, Tennessee and Birmingham, Alabama. It found that arrest rates of people with mental illness were 2% in the Memphis department with the CIT model and 13% in the Birmingham department with the co-responder model. In a different community without a specialized police program (neither CIT nor co-responder), there was a 16% arrest rate for individuals with mental illness.42

By increasingly diverting people with mental illness to mental health services and thus decreasing the amount of time officers spend responding to a mental health call as well as decreasing arrests, the CIT model keeps the focus of law enforcement on crime.

Provides cost savings for law enforcement agencies:

Compared to community-based treatment, incarceration is costly. In Detroit, for example, community-based mental health treatment costs $10,000 a year, while an inmate with mental illness in hail costs $31,000 a year – more than 3 times as much as the community-based treatment.43
In studies of outcomes of pre and post-arrest diversion programs, diverted individuals with mental illnesses “incurred lower criminal justice costs and greater treatment costs than those who were not diverted.”44
The implementation of CIT in the Albuquerque (New Mexico) Police Department saw a 58% decrease in the use of SWAT teams involving a mental health crisis intervention. Since SWAT call-outs are very expensive, reduced use of them produces cost savings.45
Since the implementation of the CIT program in the Memphis Police Department saw a nearly 50% decrease in the number of TACT (Tactical Apprehension Containment Team, similar to SWAT) calls.46

Limitations of CIT:

Although the CIT model has several established benefits and continues to be held in high regard, it does have a few limitations that indicate room for improvement in both the model itself and the way it is used. One such limitation is that CIT training tends to be adopted by counties with higher rates of police killings and violent crimes, despite a finding that it may perhaps “fare better if conditions of police use of lethal force were less acute.”47 Since mental health issues are common across any area and should thus be considered everywhere, and further do not have an established correlation with violence, CIT training should not necessarily be more promoted in areas with high rates of violent crimes or police killings.

Several areas with high CIT exposure do not have decreased likelihood that persons in mental health crisis will be fatally shot by police officers.48 This is due to another limitation in the way in which the CIT model is used: states having high CIT exposure do not necessarily have a high number of CIT-trained officers. As a result, “the first officers to arrive and respond to a particular situation may not have undergone [CIT] training,” even in these areas with high CIT exposure.49 Thus, the CIT model could be improved by more effective dispatching of CIT trained officers to crises involving persons with mental illness.

This is supported by a study by Compton et al, which found that “some CIT programs have not fully implemented dispatch protocols and training of dispatch personnel” and that “CIT programs that have implemented dispatch training have used varied approaches.”50 This disparity between CIT programs in different departments and the “inconsistency in how police officers are CIT-trained,”51 notes another limitation in the CIT model. Even if the training component of the CIT program has been successfully implemented, police departments may struggle to “maintain training for police dispatchers, lack psychiatric facilities to assist offers, and face unique challenges in implementing the program in rural settings,”52 all of which may prevent the model from effectively achieving all of its potential benefits.

The lack of adaptation of the CIT training program’s design process has been called “one of [its] largest pitfalls.”53 Since CIT training programs are based on a standard model (the Memphis model), some jurisdictions adopting this standard CIT model may struggle with “the uncertainty of ‘tailor[ing] models from other jurisdictions to their own distinct problems and circumstances.”54 This may pose challenges for departments and create some unanswered questions for police officers regarding what to do in certain situations. For example, a police department in the Ninth Circuit adopting a CIT model developed by a department in the Fifth Circuit would not have information on the accommodations an officer can make for an individual in mental health crisis “given the two circuits’ differing interpretations of Title II.”55

The shortcomings of the CIT model have led to the development of a Police-Mental Health Collaboration model (PMHC model) by the Council on State Governance and DOJ’s Bureau of Justice Assistance. This model is currently being tested in 13 different police departments, and is comprised of 10 key elements which aim to improve upon some of the limitations of the CIT model.56 4 of these elements are:

1. The proposed PHMC Model centers around “collaborative planning and implementation,” uniting representatives from “a wide range of disciplines and perspectives.” A coordination group would oversee officer training to measure the progress and effectiveness of the program.57

2. The coordination group is responsible for the design of the program, meaning it considers the unique needs and capabilities of individual police departments. This group would also focus on ensuring “limited wait times for trained officers or that trained officers are dispatched with responding officers.58

3. Unlike the CIT model which focuses on training a certain group of officers who volunteered for the training, the PMHC Model “would require training of police officers, dispatchers, call takers,” and other supporting individuals, and this training would be specialized for the needs of each particular job.59

4. Specific training and protocols would be provided to dispatchers and call takers.60

1. “CIT Center.” Overview, http://www.cit.memphis.edu/overview.php.

2. Ibid.

3. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

4. “CIT Center.” Overview, http://www.cit.memphis.edu/overview.php.

5. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

6. Ibid.

7. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

8. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

9. Ibid.

10. Ibid.

11. Ibid.

12. Ibid.

13. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

14. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

15. Ibid.

16. Kerle, Ken. “The Mentally Ill and Crisis Intervention Teams.” The Prison Journal, vol. 96, no. 1, 2015, pp. 153–161., https://doi.org/10.1177/0032885515605497.

17. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

18. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

19. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

20. Ibid.

21. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

22. Ibid.

23. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

24. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

25. Ibid.

26. Ibid.

27. Hanna, Andrew C. “Municipal Liability and Police Training for Mental Illness: Causes of Action and Feasible Solutions.” Indiana Health Law Review, vol. 14, no. 2, 2017, p. 221., https://doi.org/10.18060/3911.0039.

28. Ibid.

29. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

30. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

31. Ibid.

32. Ibid.

33. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

34. Ibid.

35. Ibid.

36. Ibid.

37. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

38. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

39. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

40 Ibid.

41. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

42. Ibid.

43. “Crisis Intervention Team (CIT) Programs.” NAMI, https://nami.org/Advocacy/Crisis-Intervention/Crisis-Intervention-Team-(CIT)-Programs.

44. Reuland, Melissa, et al. “Law Enforcement Responses to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice.” CSG Justice Center, 9 Feb. 2020, https://csgjusticecenter.org/publications/law-enforcement-responses-to-people-with-mental-illnesses-a-guide-to-research-informed-policy-and-practice/.

45. Ibid.

46. Ibid.

47. Fagan, Jeffrey and Campbell, Alexis, Race and Reasonableness in Police Killings (May 7, 2020). Boston University Law Review, Vol. 100, 2020, Columbia Public Law Research Paper No. 14-655, Available at SSRN: https://ssrn.com/abstract=3596274

48. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

49. Ibid.

50. Watson, Amy C, and Anjali J Fulambarker. “The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners.” Best practices in mental health vol. 8,2 (2012): 71.

51. Campbell, Alexis. “Failure on the Front Line: How the Americans with Disabilities Act Should Be Interpreted to Better Protect Persons in Mental Health Crisis from Fatal Police Shootings.” Columbia Human Rights Law Review, 2019, http://hrlr.law.columbia.edu/hrlr/failure-on-the-front-line-how-the-americans-with-disabilities-act-should-be-interpreted-to-better-protect-persons-in-mental-health-crisis-from-fatal-police-shootings/.

52. Ibid.

53. Ibid.

54. Ibid.

55. Ibid.

56. Ibid

57. Ibid

58. Ibid

59. Ibid

60. Ibid