Gregory Wadsworth
University of New Haven
Nearly half a million people were held in psychiatric hospitals and mental institutions in 1950, but that number rapidly declined to 100,000 in 1980 (Slate, 2016, p. 341) and to 50,000 in 2000 (Roth, 2020, p. 2). This decline, known as deinstitutionalization, placed many mentally ill individuals into the community, with inadequate resources and treatment (Slate, 2016). Many of those released individuals became homeless, and many were arrested and incarcerated, mostly for minor offenses. This mass incarceration of the mentally ill, which has persisted for decades, has been referred to as the “criminalization of mental illness” (Slate, 2016, p. 347). It has been suggested that half of all Americans suffering from serious mental illness will be arrested during their adult life (Draine et al., 2002, p. 565). Currently, estimates suggest that 56% of state prisoners and 64% of jail inmates suffer from a mental health issue; however, only 10.6% of the U.S. population reportedly has a mental disorder (James & Glaze, 2006, p. 3). More recently, Bronson and Berzofsky (2017) revealed that about 14% of state and federal prisoners and 25% of jail inmates suffer from a serious mental illness, compared to only 5% of the U.S. population (p. 4).
Estimates also suggest that about 25% of all fatal police shootings involve a mentally ill suspect (Roth, 2020, p. 3). The high volume of arrests and fatal shootings involving the mentally ill, in addition to public outcry, fueled the development of better police policies and practices for responding to mental health-related calls. One of the most well-studied and frequently implemented interventions to improve officer responses to the mentally ill is the crisis intervention team. Crisis intervention team (CIT) training initially was developed by the Memphis Police Department in 1988 following the fatal shooting of a schizophrenic man (Roth, 2020; Canada et al., 2021; Compton 2014a; Ellis, 2014). In September 1987, Memphis police responded to a call at a housing project for a man, possibly high on cocaine and harming himself with a knife (Roth, 2020). Officers arrived on the scene and fatally shot Joseph Dewayne Robinson, an African American man suffering from paranoid schizophrenia.
Public outcry led the Memphis Police Department, in conjunction with the National Alliance on Mental Illness (NAMI), mental health professionals, and family advocates, to develop training to improve their response to mental illness (Compton 2014a; Ellis; 2014). The traditional CIT model, known as the “Memphis model,” is a voluntary program consisting of a one-week, 40-hour intensive course focusing on identifying mental illness, de-escalating situations, and diverting offenders (Ellis, 2014; Campbell et al., 2017). Another important staple of the Memphis model are no-refusal drop-offs for police (Campbell et al., 2017; Compton et al., 2014a; Compton et al., 2014b). No-refusal clinics are predesignated drop-offs that allow the police to quickly and easily divert offenders from the criminal justice system (Campbell et al., 2017). The intensive training and community support have made the Memphis model the “gold standard” for CIT training (Campbell et al., 2017, p. 204). Current estimates suggest that CIT has been replicated in over 400 jurisdictions domestically and over 1,500 internationally (Davidson, 2016).
The rapid expansion, and apparent success, of CIT in law enforcement led the intervention to be adapted for corrections. With a high proportion of inmates experiencing symptoms of mental illness, there was a need for an effective intervention to improve correctional officer responses to inmate distress. The current paper will review existing literature on the effectiveness of CIT in law enforcement, the early research on CIT implementation in corrections, and three contemporary research articles on the effectiveness of CIT in corrections. Additionally, this paper will discuss policy implications and avenues for future research.
CIT and Law Enforcement
The Memphis police department developed CIT to improve the overall interaction between law enforcement and the mentally ill. Specifically, there are three main goals of CIT training: (1) improve officers’ knowledge of mental health, (2) reduce use of force, and (3) increase diversion to treatment (Davidson, 2016; Watson, 2010; Compton et al., 2014a). The ability of CIT to achieve these goals in law enforcement has been well researched.
Research on the first goal of CIT — improving officers’ knowledge of mental illness and their confidence in responding to mental health crises (i.e., officer self-efficacy) — has produced important findings. Compton et al. (2014a) surveyed 251 CIT and 335 non-CIT officers in Georgia and found that CIT officers performed better on measures of mental health knowledge and had greater self-efficacy than non-CIT officers. Ellis (2014), using pre-test/post-test data from 25 officers in Florida, found that CIT training improved officers’ scores on measures of mental health knowledge. Davidson (2016) also studied CIT in Florida. Utilizing a sample of 279 police officers, she found that CIT training significantly improved officers’ knowledge about mental illness and self-efficacy. The improved mental health knowledge persisted at a 1-month follow-up, but the improved self-efficacy had decayed by 22% (p. 63). Lastly, Ritter et al. (2010) studied CIT in an undisclosed Midwestern city using a vignette (i.e., a scenario design) depicting a schizophrenic individual. They found that CIT officers reported significantly greater self-efficacy than non-CIT officers, and this result persisted at a 1-year follow-up. Overall, the literature suggests that CIT training improves officers’ mental health knowledge, but benefits to officer self-efficacy may be subject to decay.
The literature examining the second goal of CIT training (i.e., reducing use of force) has produced mixed findings. Compton et al. (2014b) studied CIT in Georgia by sampling 1,063 incident reports from 91 CIT and 89 non-CIT officers (p. 524). Their results indicate that CIT officers were significantly more likely to utilize verbal de-escalation than non-CIT officers. However, there was no significant difference in the use of force. Morabito et al. (2012) studied CIT by interviewing 91 CIT and 125 non-CIT trained officers in four districts in Chicago. Their results indicate that CIT officers were more likely to use force than non-CIT-trained officers, but the findings were not statistically significant. However, they also found that CIT officers were less likely to respond with force to a resistant offender. Skeem and Bibeau (2008) examined CIT in Las Vegas by analyzing 655 CIT officer incident reports and compared their results to previous studies of police use of force. For example, Garner and Maxwell (1999, as cited in Skeem & Bibeau, 2008), using a sample of 7,500 arrests from 110 police agencies, found that police used force in 17% of incidents. Skeem and Bibeau (2008) found that CIT officers utilized force in 6% of incidents (p. 204). Finally, Compton et al. (2015) used a sample of 353 officers from Georgia and found that CIT reduced officer use of force in response to a vignette depicting a psychotic offender. In sum, the current literature is unclear as to whether CIT training effectively reduces police officer use of force.
Lastly, research on the final goal of CIT — reducing arrest and increasing diversion — also has uncovered mixed support. Teller et al. (2006), examining 10,004 mental health-related calls that occurred in Akron, Ohio (p. 234), found no significant difference in arrests between CIT and non-CIT trained officers. Watson (2010) studied CIT by interviewing 91 CIT and 125 non-CIT officers in Chicago, finding no significant difference in arrests. Franz and Borum (2011) studied CIT in Florida and found that only 3% of CIT-related calls ended in arrest, which was substantially lower than the estimated number of arrests that would have occurred (19%) if CIT was not implemented (p. 269). Lastly, Compton et al. (2014b) found that CIT officers were significantly less likely to arrest a mentally ill suspect than non-CIT trained officers. In general, the current body of literature suggests that CIT training either reduces an officer’s likelihood of making an arrest or has a null effect.
Early Research on CIT in Corrections
Research on the expansion of CIT into corrections is limited. One of the earliest studies was conducted in Maine (University of New England Center for Health Policy, Planning and Research, 2007). Researchers examined CIT using self-report data and jail incident reports. This early research found that CIT-trained correctional officers reported greater knowledge and self-efficacy and decreased use of force. The examination of jail incident reports found that mental health-related incidents fluctuated greatly by month, but no significant effect could be attributed to CIT training. Another examination was conducted by Davidson (2016), who utilized a sample of both police and correctional officers. Davidson (2016) studied CIT by testing officers before, immediately after, and one month following CIT training. The results indicated that CIT immediately improved officers’ knowledge, self-efficacy, and perceptions towards verbal de-escalation; however, the improved self-efficacy and perceptions towards de-escalation decayed by 22% and 28% respectively by the one-month follow-up (p. 63). Therefore, early research on CIT implementation in corrections suggested that additional training improves officer knowledge about mental illness, but may not reduce officer use of force or improve self-efficacy.
Contemporary Research on CIT in Corrections
A recent study of CIT implementation in corrections was conducted by McNeeley and Donley (2021). They examined how CIT implementation by the Minnesota Department of Corrections (MnDOC) affected mental health referrals, inmate compliance, and correctional officer use of force. They analyzed 500 randomly selected incident reports from Minnesota Correctional Facility - Oak Park Heights that involved face-to-face contact between an inmate and a guard (p. 199). Utilizing logistic regression analysis, McNeeley and Donley (2021) examined the effects of correctional officer (CO) CIT status and proportion of CIT trained officers present on the likelihood of mental health referrals, inmate compliance, and correctional officer use of force. They found that CIT training did not improve inmate immediate compliance. The results did indicate, however, that CIT training increased the likelihood of eventual compliance by over 200%. Having a greater proportion of CIT-trained officers respond also significantly improved the likelihood of eventual compliance. Beyond compliance, McNeeley and Donley (2021) found that CIT training was associated with over a 350% increased likelihood of referring an inmate to mental health services. Lastly, their results indicate that CIT training was not associated with any change in CO use of force. Overall, the results of this analysis show that CIT training in Minnesota was associated with increased eventual compliance and mental health referrals, but had no effect on immediate compliance or CO use of force.
Comartin et al. (2020) utilized a mixed-methods design to study the effects of CIT training on CO’s perception of mental health, use of verbal de-escalation, and use of force at the Oakland County Jail in Michigan. The authors used a pre- and post-test design to study the effects of CIT on CO perceptions. Of the 306 officers who completed CIT training, 255 participated in the current study. Additionally, 10 COs were randomly selected, using stratified sampling, to be interviewed at 6-months post-CIT training. Lastly, Comartin et al. (2020) examined incident reports from the Cell Removal Team (CRT) — a team specifically trained to physically restrain uncooperative inmates — to determine how CIT training influenced CO use of verbal de-escalation and use of force.
CO perceptions were analyzed using paired samples t-tests, and incident reports were analyzed using interrupted time-series analyses (Comartin et al., 2020). Results indicated that CIT training significantly improved CO’s understanding and perceptions of mental illness and improved CO self-efficacy. Additionally, CIT training significantly decreased the use of CRT, suggesting a significant decrease in CO use of force and improved verbal de-escalation. Moreover, during interviews, COs reported increased use of verbal de-escalation, decreased use of force, and a desire for more training on mental illness. However, interviewed COs also reported limited understanding of the available mental health resources. In sum, the results indicate that CIT training in Michigan was associated with increased CO understanding of mental illness, communication, and de-escalation, and decreased use of CRTs and CO use of force, but additional training may be needed to improve cooperation between COs and mental health staff.
Lastly, Canada et al. (2021) also utilized a mixed-methods design to study the Missouri Department of Correction’s (MiDOC) implementation of CIT training and its effects on CO’s understanding and perceptions of mental illness. Canada et al. (2021) asked the 403 COs who volunteered for CIT training to complete a pre- and post-test, which was completed by 235 COs. Seventeen CIT-trained COs were randomly selected to receive a follow-up interview at 6 months post-CIT training. To form a comparison group, Canada et al. (2021) sent a one-time survey to all non-CIT trained officers (n = 4,956), which was completed by 599 officers. CIT-volunteers and non-CIT-volunteers were compared using analysis of variance (ANOVA) to measure differences before training. Analysis of covariance (ANCOVA) was used to assess the differences between non-CIT officers, pre-CIT trained officers, and post-CIT trained officers. Lastly, interviews were analyzed using thematic analysis (i.e., coding, analyzing, and interpreting reoccurring themes).
Canada et al.’s (2021) results showed that, compared to non-CIT trained COs, CIT trained COs demonstrated improved knowledge, perceptions, and attitudes towards mental illness, and also reported increased self-efficacy. Their most important findings, however, arose from the analysis of their interviews. Interviewed CIT COs reported that they were less likely to use force and more likely to attempt de-escalation post-CIT training, but also indicated a need for additional training. Interviewed CIT officers further reported that CIT training helped them prevent situations from escalating, even though some indicated that de-escalation is ineffective when an inmate is “too” escalated (p. 24). Some interviewed COs also noted limited collaboration between CIT-trained COs and mental health staff, but the degree of collaboration varied by facility and shift. Lastly, CIT-trained COs reported that their fellow COs view the new CIT approach as simply “hugging thugs” and often attempt to rush the de-escalation process (p. 24). These results suggest that CIT training in Missouri improved CO’s perceptions of mental illness and self-efficacy, and that non-CIT-trained COs may view CIT-training unfavorably
Discussion and Implications
The Memphis police department developed CIT to improve contact between law enforcement and the mentally ill. However, the effectiveness of CIT in law enforcement remains unclear. Research generally supports that CIT improves officers’ mental health knowledge; however, research has failed to consistently demonstrate CIT’s ability to reduce arrests and use of force. CIT in corrections, however, is an emerging area of inquiry with early support for CIT’s effectiveness. Correctional research suggests that CIT improves CO mental health knowledge, decreases use of force, and increases referrals to mental health services. Based on contemporary correctional CIT research, important policy implications can be made for correctional institutions planning to implement CIT. Additionally, contemporary articles have laid the foundation for additional research.
Policy Recommendations
Comartin et al. (2020) and Canada et al. (2021), via interviews, found that COs viewed CIT training as beneficial; however, both studies also found that CIT-trained COs believed that more training was necessary. In law enforcement, dispatchers are trained to recognize mental health-related calls and alert CIT-trained officers (McNeeley & Donley, 2021). Similarly, more correctional officers need to be trained to recognize mental health crises so CIT-trained COs can respond more expediently. The first recommendation, for any jurisdiction looking to implement CIT in their jails or prisons, is to provide basic mental health training to all employees to improve their identification of mental health crises and to improve CIT officer responses.
The second policy recommendation is to require CIT intervention in mental health crises before considering using force. In some institutions studied by Canada et al. (2021), it was required for CIT officers to respond before utilizing force. Additionally, COs interviewed by Comartin et al. (2021) reported that they were pressured to de-escalate situations quickly. By incorporating CIT responses into the fabric of the correctional institution, thereby requiring CIT intervention before force, institutions can improve their responses to mental illness. McNeeley and Donley (2021) demonstrated that CIT can improve eventual compliance in inmates and reduce the need to physically restrain uncooperative inmates. Institutions could benefit from mandating CIT responses and allowing CIT officers the time necessary to de-escalate situations. Therefore, it is recommended that institutions that implement CIT also require CIT intervention before resorting to physical force.
The last recommendation is for greater collaboration between COs, particularly CIT-trained COs, and correctional mental health staff. A key component of CIT is a partnership between law enforcement and community mental health services, ideally in the form of a no-refusal drop-off center (Campbell et al., 2017). According to interviews with CIT officers, however, many still wish for greater cooperation with mental health staff (Canada et al., 2021). Correctional officers play an important role in mental health treatment within jail and prison because they have contact with inmates more regularly than mental health staff. It is recommended that correctional institutions foster greater cooperation between COs and mental health staff. Mental health staff could, therefore, be informed more quickly about changes in an inmate’s mental health, and COs could seek assistance from mental health staff during mental health crises.
Limitations and Future Research
Research on the expansion of CIT into corrections is still in its infancy. There are many limitations with the current research that should be addressed. Selection bias is a major concern when studying CIT because participation is typically voluntary. Both Comartin et al. (2021) and Canada et al. (2021) were unable to use random samples due to the voluntary nature of CIT training. Generalizability is also a major concern. McNeeley and Donley (2020) studied the effects of CIT training in a prison situated in an affluent county. The results of these studies may not generalize to jails or prisons with limited mental health resources. Future research can address the issue of generalizability by conducting research examining correctional CIT programs in jurisdictions with varying degrees of resources. Another major limitation of the current research is their reliance on self-report measures and interviews with COs. Comartin et al. (2021) and Canada et al. (2021) both demonstrated the ability to study CIT in corrections using qualitative measures, but their results are mostly limited to CO perceptions. To obtain a more detailed understanding of CIT implementation in corrections, researchers should expand their analysis to include inmate perceptions. Additionally, observations could also be beneficial for understanding guard-inmate interactions during mental health crises. CIT has been well studied in law enforcement, but the expansion of CIT into corrections has opened a new avenue for further scientific inquiry.
Conclusion
The mentally ill are over-represented at every stage of the criminal justice system. CIT was developed, initially for law enforcement, to divert mentally ill offenders away from further criminal justice involvement. However, CIT also aimed to improve officer knowledge of mental illness and reduce use of force. Both goals made CIT an attractive program for corrections. Research on the effectiveness of CIT in corrections is limited, but suggests that CIT can improve officer knowledge and self-efficacy, increase inmate compliance and mental health referrals, and reduce use of force. Thus, early research suggests that CIT training in corrections could be effective at improving guard-inmate interactions and improving the overall treatment of the incarcerated mentally ill. However, more research is needed to determine the overall effectiveness of CIT in corrections and guide future implementation efforts.
References
Bronson, J., & Berzofsky, M. (2017). Indicators of mental health problems reported by prisoners and jail inmates, 2011-12. Bureau of Justice Statistics (NCJ 250612).
Campbell, J., Ahalt, C., Hager, R., & Arroyo, W. (2017). Building on mental health training for law enforcement: Strengthening community partnerships. International Journal of Prison Health, 13(3), 207-212.
Canada, K. E., Watson, A.C., & O’Kelly, S. (2021). Utilizing crisis intervention teams in prison to improve officer knowledge, stigmatizing attitudes, and perception of response options. Criminal Justice & Behavior, 48(1), 10-31. https://doi.org/10.1177/0093854820942274.
Comartin, E. B., Wells, K., Zacharias, A., & Kubiak, S. (2020). The use of the crisis intervention team (CIT) model for corrections officers: Reducing incidents within a county jail. The Prison Journal, 100(5), 581-602. https://doi.org/10.1177/0032885520956334.
Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T., D’Orio, B., Oliva, J. R., Thompson, N. J., & Watson, A. C. (2014a). The police-based crisis intervention team (CIT) model: I. Effects on officers’ knowledge, attitudes, and skills. Psychiatric Services, 65(4), 517-522. https://doi.org/10.1176/appi.ps.201300107.
Compton, M. T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T., D’Orio, B., Oliva, J. R., Thompson, N. J., & Watson, A. C. (2014b). The police-based crisis intervention team (CIT) model: II. Effects on level of force and resolution, referral, and arrest. Psychiatric Services, 65(4), 523-529. https://doi.org/10.1176/appi.ps.201300108.
Compton, M. T., Broussard, B., Reed, T. A., Crisafio, A., & Watson, A. C. (2015). Survey of police chiefs and sheriffs and of police officers about CIT program. Psychiatric Services, 66(7), 760-763. https://doi.org/10.1176/appi.ps.201300451.
Davidson, M. L. (2016). A criminal justice system-wide response to mental illness: Evaluating the effectiveness of the Memphis model crisis intervention team training curriculum among law enforcement and correctional officers. Criminal Justice Policy Review, 27(1), 46-75. https://doi.org/10.1177/0887403414554997.
Draine, J., Salzer, M. S., Culhane, D. P., & Hadley, T. R. (2002). Role of social disadvantage in crime, joblessness, and homelessness among persons with mental illness. Psychiatric Services, 53(5), 565-573. https://doi.org/10.1176/appi.ps.53.5.565.
Ellis, H. A. (2014). Effects of a crisis intervention team (CIT) training program upon police officers before and after crisis intervention team training. Archives of Psychiatric Nursing, 26, 10-16. https://doi.org/10.1016/j.apnu.2013.10.003.
Garner, J. H., & Mazwell, C. D. (1999). Measuring the amount of force used by and against the police in six jurisdictions, in use of force by police: Overview of national and local data. Bureau of Justice Statistics (NCJ 176330).
James, D. J., & Glaze, L. E. (2006). Mental health problems of prison and jail inmates. Bureau of Justice Statistics (NCJ 213600).
McNeeley, S. & Donley, C. (2021). Crisis intervention team training in a correctional setting: Examining compliance, mental health referrals, and use of force. Criminal Justice and Behavior, 48(2), 195-214. https://doi.org/10.1177/0093854820959394.
Morabito, M. S., Kerr, A. N., Watson, A., Draine, J., Ottati, V., & Angell, B. (2020). Crisis intervention teams and people with mental illness: Exploring the factors that influence the use of force. Crime & Delinquency, 58(1), 57-77. https://doi.org/10.1177/0011128710372456.
Ritter, C., Teller. J. L. S., Munetz, M. R., & Bonfire, N. (2010). Crisis intervention team (CIT) training: Selection effects and long-term changes in perceptions of mental illness and community preparedness. Journal of Police Crisis Negotiations, 10, 133-152. https://doi.org/10.1080/15332581003756992.
Roth, A. (2020). Insane: America’s criminal treatment of mental illness. Basic Books.
Skeem, J., & Bibeau, L. (2008). How does violence potential relate to crisis intervention team responses to emergencies? Psychiatric Services, 59(2), 201-204. DOI: 10.1176/ps.2008.59.2.201.
Slate, R. N. (2016). Deinstitutionalization, criminalization of mental illness, and the principle of therapeutic jurisprudence. Southern California Interdisciplinary Law Journal, 26, 342-355.
Teller, J. L. S., Munetz, M. R., Gil, K. M., & Ritter, C. (2006). Crisis intervention team training for police officers responding to mental disturbance calls. Psychiatric Services, 57(2), 232-237. https://doi.org/10.1176/appi.ps.57.2.232.
University of New England Center for Health Policy, Planning and Research. (2007). Crisis Intervention Team (CIT) training for correctional officers: An evaluation of NAMI Maine's 2005-2007 expansion program. Retrieved from http://www.pacenterofexcellence.pitt.edu/documents/Maine%20NAMI%20CIT-3.pdf.
Watson, A. C. (2010). Research in the real world: Studying Chicago police department’s crisis intervention team program. Research on Social Work, 20(5), 536-543. https://doi.org/10.1177/1049731510374201.
Gregory Wadsworth
University of New Haven
Nearly half a million people were held in psychiatric hospitals and mental institutions in 1950, but that number rapidly declined to 100,000 in 1980 (Slate, 2016, p. 341) and to 50,000 in 2000 (Roth, 2020, p. 2). This decline, known as deinstitutionalization, placed many mentally ill individuals into the community, with inadequate resources and treatment (Slate, 2016). Many of those released individuals became homeless, and many were arrested and incarcerated, mostly for minor offenses. This mass incarceration of the mentally ill, which has persisted for decades, has been referred to as the “criminalization of mental illness” (Slate, 2016, p. 347). It has been suggested that half of all Americans suffering from serious mental illness will be arrested during their adult life (Draine et al., 2002, p. 565). Currently, estimates suggest that 56% of state prisoners and 64% of jail inmates suffer from a mental health issue; however, only 10.6% of the U.S. population reportedly has a mental disorder (James & Glaze, 2006, p. 3). More recently, Bronson and Berzofsky (2017) revealed that about 14% of state and federal prisoners and 25% of jail inmates suffer from a serious mental illness, compared to only 5% of the U.S. population (p. 4).
Estimates also suggest that about 25% of all fatal police shootings involve a mentally ill suspect (Roth, 2020, p. 3). The high volume of arrests and fatal shootings involving the mentally ill, in addition to public outcry, fueled the development of better police policies and practices for responding to mental health-related calls. One of the most well-studied and frequently implemented interventions to improve officer responses to the mentally ill is the crisis intervention team. Crisis intervention team (CIT) training initially was developed by the Memphis Police Department in 1988 following the fatal shooting of a schizophrenic man (Roth, 2020; Canada et al., 2021; Compton 2014a; Ellis, 2014). In September 1987, Memphis police responded to a call at a housing project for a man, possibly high on cocaine and harming himself with a knife (Roth, 2020). Officers arrived on the scene and fatally shot Joseph Dewayne Robinson, an African American man suffering from paranoid schizophrenia.
Public outcry led the Memphis Police Department, in conjunction with the National Alliance on Mental Illness (NAMI), mental health professionals, and family advocates, to develop training to improve their response to mental illness (Compton 2014a; Ellis; 2014). The traditional CIT model, known as the “Memphis model,” is a voluntary program consisting of a one-week, 40-hour intensive course focusing on identifying mental illness, de-escalating situations, and diverting offenders (Ellis, 2014; Campbell et al., 2017). Another important staple of the Memphis model are no-refusal drop-offs for police (Campbell et al., 2017; Compton et al., 2014a; Compton et al., 2014b). No-refusal clinics are predesignated drop-offs that allow the police to quickly and easily divert offenders from the criminal justice system (Campbell et al., 2017). The intensive training and community support have made the Memphis model the “gold standard” for CIT training (Campbell et al., 2017, p. 204). Current estimates suggest that CIT has been replicated in over 400 jurisdictions domestically and over 1,500 internationally (Davidson, 2016).
The rapid expansion, and apparent success, of CIT in law enforcement led the intervention to be adapted for corrections. With a high proportion of inmates experiencing symptoms of mental illness, there was a need for an effective intervention to improve correctional officer responses to inmate distress. The current paper will review existing literature on the effectiveness of CIT in law enforcement, the early research on CIT implementation in corrections, and three contemporary research articles on the effectiveness of CIT in corrections. Additionally, this paper will discuss policy implications and avenues for future research.
CIT and Law Enforcement
The Memphis police department developed CIT to improve the overall interaction between law enforcement and the mentally ill. Specifically, there are three main goals of CIT training: (1) improve officers’ knowledge of mental health, (2) reduce use of force, and (3) increase diversion to treatment (Davidson, 2016; Watson, 2010; Compton et al., 2014a). The ability of CIT to achieve these goals in law enforcement has been well researched.
Research on the first goal of CIT — improving officers’ knowledge of mental illness and their confidence in responding to mental health crises (i.e., officer self-efficacy) — has produced important findings. Compton et al. (2014a) surveyed 251 CIT and 335 non-CIT officers in Georgia and found that CIT officers performed better on measures of mental health knowledge and had greater self-efficacy than non-CIT officers. Ellis (2014), using pre-test/post-test data from 25 officers in Florida, found that CIT training improved officers’ scores on measures of mental health knowledge. Davidson (2016) also studied CIT in Florida. Utilizing a sample of 279 police officers, she found that CIT training significantly improved officers’ knowledge about mental illness and self-efficacy. The improved mental health knowledge persisted at a 1-month follow-up, but the improved self-efficacy had decayed by 22% (p. 63). Lastly, Ritter et al. (2010) studied CIT in an undisclosed Midwestern city using a vignette (i.e., a scenario design) depicting a schizophrenic individual. They found that CIT officers reported significantly greater self-efficacy than non-CIT officers, and this result persisted at a 1-year follow-up. Overall, the literature suggests that CIT training improves officers’ mental health knowledge, but benefits to officer self-efficacy may be subject to decay.
The literature examining the second goal of CIT training (i.e., reducing use of force) has produced mixed findings. Compton et al. (2014b) studied CIT in Georgia by sampling 1,063 incident reports from 91 CIT and 89 non-CIT officers (p. 524). Their results indicate that CIT officers were significantly more likely to utilize verbal de-escalation than non-CIT officers. However, there was no significant difference in the use of force. Morabito et al. (2012) studied CIT by interviewing 91 CIT and 125 non-CIT trained officers in four districts in Chicago. Their results indicate that CIT officers were more likely to use force than non-CIT-trained officers, but the findings were not statistically significant. However, they also found that CIT officers were less likely to respond with force to a resistant offender. Skeem and Bibeau (2008) examined CIT in Las Vegas by analyzing 655 CIT officer incident reports and compared their results to previous studies of police use of force. For example, Garner and Maxwell (1999, as cited in Skeem & Bibeau, 2008), using a sample of 7,500 arrests from 110 police agencies, found that police used force in 17% of incidents. Skeem and Bibeau (2008) found that CIT officers utilized force in 6% of incidents (p. 204). Finally, Compton et al. (2015) used a sample of 353 officers from Georgia and found that CIT reduced officer use of force in response to a vignette depicting a psychotic offender. In sum, the current literature is unclear as to whether CIT training effectively reduces police officer use of force.
Lastly, research on the final goal of CIT — reducing arrest and increasing diversion — also has uncovered mixed support. Teller et al. (2006), examining 10,004 mental health-related calls that occurred in Akron, Ohio (p. 234), found no significant difference in arrests between CIT and non-CIT trained officers. Watson (2010) studied CIT by interviewing 91 CIT and 125 non-CIT officers in Chicago, finding no significant difference in arrests. Franz and Borum (2011) studied CIT in Florida and found that only 3% of CIT-related calls ended in arrest, which was substantially lower than the estimated number of arrests that would have occurred (19%) if CIT was not implemented (p. 269). Lastly, Compton et al. (2014b) found that CIT officers were significantly less likely to arrest a mentally ill suspect than non-CIT trained officers. In general, the current body of literature suggests that CIT training either reduces an officer’s likelihood of making an arrest or has a null effect.
Early Research on CIT in Corrections
Research on the expansion of CIT into corrections is limited. One of the earliest studies was conducted in Maine (University of New England Center for Health Policy, Planning and Research, 2007). Researchers examined CIT using self-report data and jail incident reports. This early research found that CIT-trained correctional officers reported greater knowledge and self-efficacy and decreased use of force. The examination of jail incident reports found that mental health-related incidents fluctuated greatly by month, but no significant effect could be attributed to CIT training. Another examination was conducted by Davidson (2016), who utilized a sample of both police and correctional officers. Davidson (2016) studied CIT by testing officers before, immediately after, and one month following CIT training. The results indicated that CIT immediately improved officers’ knowledge, self-efficacy, and perceptions towards verbal de-escalation; however, the improved self-efficacy and perceptions towards de-escalation decayed by 22% and 28% respectively by the one-month follow-up (p. 63). Therefore, early research on CIT implementation in corrections suggested that additional training improves officer knowledge about mental illness, but may not reduce officer use of force or improve self-efficacy.
Contemporary Research on CIT in Corrections
A recent study of CIT implementation in corrections was conducted by McNeeley and Donley (2021). They examined how CIT implementation by the Minnesota Department of Corrections (MnDOC) affected mental health referrals, inmate compliance, and correctional officer use of force. They analyzed 500 randomly selected incident reports from Minnesota Correctional Facility - Oak Park Heights that involved face-to-face contact between an inmate and a guard (p. 199). Utilizing logistic regression analysis, McNeeley and Donley (2021) examined the effects of correctional officer (CO) CIT status and proportion of CIT trained officers present on the likelihood of mental health referrals, inmate compliance, and correctional officer use of force. They found that CIT training did not improve inmate immediate compliance. The results did indicate, however, that CIT training increased the likelihood of eventual compliance by over 200%. Having a greater proportion of CIT-trained officers respond also significantly improved the likelihood of eventual compliance. Beyond compliance, McNeeley and Donley (2021) found that CIT training was associated with over a 350% increased likelihood of referring an inmate to mental health services. Lastly, their results indicate that CIT training was not associated with any change in CO use of force. Overall, the results of this analysis show that CIT training in Minnesota was associated with increased eventual compliance and mental health referrals, but had no effect on immediate compliance or CO use of force.
Comartin et al. (2020) utilized a mixed-methods design to study the effects of CIT training on CO’s perception of mental health, use of verbal de-escalation, and use of force at the Oakland County Jail in Michigan. The authors used a pre- and post-test design to study the effects of CIT on CO perceptions. Of the 306 officers who completed CIT training, 255 participated in the current study. Additionally, 10 COs were randomly selected, using stratified sampling, to be interviewed at 6-months post-CIT training. Lastly, Comartin et al. (2020) examined incident reports from the Cell Removal Team (CRT) — a team specifically trained to physically restrain uncooperative inmates — to determine how CIT training influenced CO use of verbal de-escalation and use of force.
CO perceptions were analyzed using paired samples t-tests, and incident reports were analyzed using interrupted time-series analyses (Comartin et al., 2020). Results indicated that CIT training significantly improved CO’s understanding and perceptions of mental illness and improved CO self-efficacy. Additionally, CIT training significantly decreased the use of CRT, suggesting a significant decrease in CO use of force and improved verbal de-escalation. Moreover, during interviews, COs reported increased use of verbal de-escalation, decreased use of force, and a desire for more training on mental illness. However, interviewed COs also reported limited understanding of the available mental health resources. In sum, the results indicate that CIT training in Michigan was associated with increased CO understanding of mental illness, communication, and de-escalation, and decreased use of CRTs and CO use of force, but additional training may be needed to improve cooperation between COs and mental health staff.
Lastly, Canada et al. (2021) also utilized a mixed-methods design to study the Missouri Department of Correction’s (MiDOC) implementation of CIT training and its effects on CO’s understanding and perceptions of mental illness. Canada et al. (2021) asked the 403 COs who volunteered for CIT training to complete a pre- and post-test, which was completed by 235 COs. Seventeen CIT-trained COs were randomly selected to receive a follow-up interview at 6 months post-CIT training. To form a comparison group, Canada et al. (2021) sent a one-time survey to all non-CIT trained officers (n = 4,956), which was completed by 599 officers. CIT-volunteers and non-CIT-volunteers were compared using analysis of variance (ANOVA) to measure differences before training. Analysis of covariance (ANCOVA) was used to assess the differences between non-CIT officers, pre-CIT trained officers, and post-CIT trained officers. Lastly, interviews were analyzed using thematic analysis (i.e., coding, analyzing, and interpreting reoccurring themes).
Canada et al.’s (2021) results showed that, compared to non-CIT trained COs, CIT trained COs demonstrated improved knowledge, perceptions, and attitudes towards mental illness, and also reported increased self-efficacy. Their most important findings, however, arose from the analysis of their interviews. Interviewed CIT COs reported that they were less likely to use force and more likely to attempt de-escalation post-CIT training, but also indicated a need for additional training. Interviewed CIT officers further reported that CIT training helped them prevent situations from escalating, even though some indicated that de-escalation is ineffective when an inmate is “too” escalated (p. 24). Some interviewed COs also noted limited collaboration between CIT-trained COs and mental health staff, but the degree of collaboration varied by facility and shift. Lastly, CIT-trained COs reported that their fellow COs view the new CIT approach as simply “hugging thugs” and often attempt to rush the de-escalation process (p. 24). These results suggest that CIT training in Missouri improved CO’s perceptions of mental illness and self-efficacy, and that non-CIT-trained COs may view CIT-training unfavorably
Discussion and Implications
The Memphis police department developed CIT to improve contact between law enforcement and the mentally ill. However, the effectiveness of CIT in law enforcement remains unclear. Research generally supports that CIT improves officers’ mental health knowledge; however, research has failed to consistently demonstrate CIT’s ability to reduce arrests and use of force. CIT in corrections, however, is an emerging area of inquiry with early support for CIT’s effectiveness. Correctional research suggests that CIT improves CO mental health knowledge, decreases use of force, and increases referrals to mental health services. Based on contemporary correctional CIT research, important policy implications can be made for correctional institutions planning to implement CIT. Additionally, contemporary articles have laid the foundation for additional research.
Policy Recommendations
Comartin et al. (2020) and Canada et al. (2021), via interviews, found that COs viewed CIT training as beneficial; however, both studies also found that CIT-trained COs believed that more training was necessary. In law enforcement, dispatchers are trained to recognize mental health-related calls and alert CIT-trained officers (McNeeley & Donley, 2021). Similarly, more correctional officers need to be trained to recognize mental health crises so CIT-trained COs can respond more expediently. The first recommendation, for any jurisdiction looking to implement CIT in their jails or prisons, is to provide basic mental health training to all employees to improve their identification of mental health crises and to improve CIT officer responses.
The second policy recommendation is to require CIT intervention in mental health crises before considering using force. In some institutions studied by Canada et al. (2021), it was required for CIT officers to respond before utilizing force. Additionally, COs interviewed by Comartin et al. (2021) reported that they were pressured to de-escalate situations quickly. By incorporating CIT responses into the fabric of the correctional institution, thereby requiring CIT intervention before force, institutions can improve their responses to mental illness. McNeeley and Donley (2021) demonstrated that CIT can improve eventual compliance in inmates and reduce the need to physically restrain uncooperative inmates. Institutions could benefit from mandating CIT responses and allowing CIT officers the time necessary to de-escalate situations. Therefore, it is recommended that institutions that implement CIT also require CIT intervention before resorting to physical force.
The last recommendation is for greater collaboration between COs, particularly CIT-trained COs, and correctional mental health staff. A key component of CIT is a partnership between law enforcement and community mental health services, ideally in the form of a no-refusal drop-off center (Campbell et al., 2017). According to interviews with CIT officers, however, many still wish for greater cooperation with mental health staff (Canada et al., 2021). Correctional officers play an important role in mental health treatment within jail and prison because they have contact with inmates more regularly than mental health staff. It is recommended that correctional institutions foster greater cooperation between COs and mental health staff. Mental health staff could, therefore, be informed more quickly about changes in an inmate’s mental health, and COs could seek assistance from mental health staff during mental health crises.
Limitations and Future Research
Research on the expansion of CIT into corrections is still in its infancy. There are many limitations with the current research that should be addressed. Selection bias is a major concern when studying CIT because participation is typically voluntary. Both Comartin et al. (2021) and Canada et al. (2021) were unable to use random samples due to the voluntary nature of CIT training. Generalizability is also a major concern. McNeeley and Donley (2020) studied the effects of CIT training in a prison situated in an affluent county. The results of these studies may not generalize to jails or prisons with limited mental health resources. Future research can address the issue of generalizability by conducting research examining correctional CIT programs in jurisdictions with varying degrees of resources. Another major limitation of the current research is their reliance on self-report measures and interviews with COs. Comartin et al. (2021) and Canada et al. (2021) both demonstrated the ability to study CIT in corrections using qualitative measures, but their results are mostly limited to CO perceptions. To obtain a more detailed understanding of CIT implementation in corrections, researchers should expand their analysis to include inmate perceptions. Additionally, observations could also be beneficial for understanding guard-inmate interactions during mental health crises. CIT has been well studied in law enforcement, but the expansion of CIT into corrections has opened a new avenue for further scientific inquiry.
Conclusion
The mentally ill are over-represented at every stage of the criminal justice system. CIT was developed, initially for law enforcement, to divert mentally ill offenders away from further criminal justice involvement. However, CIT also aimed to improve officer knowledge of mental illness and reduce use of force. Both goals made CIT an attractive program for corrections. Research on the effectiveness of CIT in corrections is limited, but suggests that CIT can improve officer knowledge and self-efficacy, increase inmate compliance and mental health referrals, and reduce use of force. Thus, early research suggests that CIT training in corrections could be effective at improving guard-inmate interactions and improving the overall treatment of the incarcerated mentally ill. However, more research is needed to determine the overall effectiveness of CIT in corrections and guide future implementation efforts.
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