law enforcement training strategies

Improving Responses toPeople with Mental Illnesses

Strategies for EffectiveLaw Enforcement Training

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Improving Responses toPeople with Mental IllnessesStrategies for EffectiveLaw EnforcementTraining

A report prepared by theCouncil of State Governments Justice Centerin partnership with the Police Executive Research Forum

for the

Bureau of JusticeAssistanceOffice of Justice ProgramsU.S. Department of Justice

Melissa ReulandMatt Schwarzfeld

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This report was prepared by the Council of State Governments Justice Center, in partnership

with the Police Executive Research Forum. It was supported by Grant No. 2005–MU–BX–K208

awarded by the Bureau of JusticeAssistance.The Bureau of JusticeAssistance is a component of

the Office of Justice Programs,which also includes the Bureau of Justice Statistics, the National

Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, and theOffice for

Victims of Crime. Points of view or opinions in this document are those of the authors and do

not represent the official position or policies of the United States Department of Justice, the

members of the Council of State Governments, or the Police Executive Research Forum.While

every effort wasmade to reach consensus and represent reviewers’ recommendations,

individual opinionsmay differ from the statementsmade in the document.

The Bureau of JusticeAssistance reserves the right to reproduce, publish, translate, or

otherwise use and to authorize others to publish and use all or any part of the copyrighted

material contained in this publication.

Web sites and sources referenced in this publication provided useful information at the time

of this writing.The authors do not necessarily endorse the information of the sponsoring

organization or other materials from these sources.

Council of State Governments Justice Center, New York 10005

© 2008 by the Council of State Governments Justice Center

Cover based on design by Nancy Kapp & Company. Interior design by DavidWilliams. Photos on

cover and on part title pages courtesy of theMontgomery County (Md.) Police Department.

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Contents

Acknowledgments vIntroduction 1

Part OneEffective Trainers

Chapter OneIdentifying Trainers 8

Challenges 9Effective Strategies 9LookingAhead 13

Chapter TwoPreparing to Teach a Law Enforcement Audience 14


Part TwoEffective Training Techniques

Chapter ThreeEnhancing Skills: The Role Play Exercise 22


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Chapter FourIncreasing Awareness: Site Visits,Testimonials, and Simulations 29

Challenges 29Effective Strategies 30

Conclusion 37

Appendix AAdvisory Board Members 39

Appendix BSuggested Training Topics 41

Appendix CCurriculum Resource List 44

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This report could not have been written without the leadership of the Bureauof Justice Assistance (BJA), Office of Justice Programs, U.S. Department ofJustice, particularly from Domingo S. Herraiz, Director; A. Elizabeth Griffith,Deputy Director for Planning; Robert Hendricks, former Policy Advisor; andMichael Guerriere, former Senior Policy Advisor for Mental Health and Sub-stance Abuse. Additional support was provided by Ruby Qazilbash, SeniorPolicy Advisor for Substance Abuse and Mental Health, and Rebecca Rose,Policy Advisor for Substance Abuse and Mental Health, during the reviewand approval process.

A group of experts on law enforcement training to improve the responseto people with mental illnesses contributed to this document. These experts,listed below, participated in interviews, provided guidance during meetings,and reviewed drafts:1

• Dr. Catherine Addy, Instructor,University of Memphis

• Major Sam Cochran, Crisis Intervention Team Coordinator, Memphis(Tenn.) Police Department

• Ms. Kate Farinholt, Executive Director, NAMI-Metropolitan Baltimore, Inc.

• Dr. Richard James, Professor, University of Memphis

• Mr. Larry Kozyra, Psychologist/Police Liaison, Detroit (Mich.) Communityand Police Partnership Advocacy, Northeast Guidance Center

• Officer Joan M. Logan, Crisis Intervention Team Coordinator, MontgomeryCounty (Md.) Police Department

• Officer Kristen McGray, Houston (Tex.) Police Department

• Lieutenant Jan Olstad, former Crisis Intervention Team Program Coordi-nator, Albuquerque (N.Mex.) Police Department

• Dr. Risdon Slate, Professor of Criminology, Florida Southern College, andconsumer of mental health services

• Officer Paul Ware, Crisis Intervention Team Coordinator, Portland (Oreg.)Police Bureau

Acknowledgments

Acknowledgments v

1. For the individuals listed here, titles and agency affiliations reflect the positions they held at the time oftheir involvement with the project.

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Strategies for Effective Law EnforcementTraining

• Officer Frank Webb, Crisis Intervention Team Coordinator, Houston (Tex.)Police Department

• Lieutenant Michael Woody (retired), Law Enforcement Liaison, OhioCriminal Justice Coordinating Center of Excellence

Thanks also are due to document reviewers. Members of the advisorygroup to the Law Enforcement/Mental Health Partnership Program providedinvaluable feedback to drafts and helped plan the project. (For a complete list-ing of the project’s advisory group, see appendix A: Advisory Board Members.)

A special thanks must be given to Council of State Governments JusticeCenter Communications Director Martha Plotkin, who edited the report atvarious stages, Justice Center Director Mike Thompson, and Health Systemsand Services Policy Director Fred Osher for their insights in helping shapethe scope and strategy of this publication. Justice Center Research AssociateLaura Draper also was instrumental in ensuring the document is accurateand responsive to the needs of practitioners. In addition, the authors appreci-ate the ongoing support that the Police Executive Research Forum’s ExecutiveDirector, Chuck Wexler, has provided.

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What Are Specialized Law Enforcement–BasedResponse Programs?

This guide uses the term “specialized law enforcement–based response”to describe programs thatmeet three criteria: (1) they enhance tradi-tional law enforcement roles in order to provide a new set of responseoptions for frontline personnel that are tailored to the needs of peoplewithmental illnesses; (2) when appropriate, they establish a link forthese individuals to services in the community; and (3) they are based inlaw enforcement agencieswith strong collaborative ties tomental healthpartners, other criminal justice agencies, and communitymembers.

This term includes both the crisis intervention team (CIT) modeland the law enforcement–mental health co-responder model. Originat-ing in the Memphis (Tenn.) Police Department (and often called theMemphis Model), the CIT model calls for training and deployment ofself-selected officers to provide a first response to the majority of inci-dents involving people with mental illnesses. This model is designed tode-escalate tensions at the scene and to reduce the need for use offorce during these types of encounters.

The co-responder model was developed in LosAngeles County andimplemented soon after in San Diego (Calif.). Leaders in those jurisdic-tions were concerned that they were unable to link people with mentalillnesses to appropriate services or provide other effective and efficientresponses. Specifically, they found that limitations on officers’ time andlack of awareness about both community mental health resources andthe characteristics of individuals who need access to those serviceswere significant problems.The resulting model pairs specially trainedofficers with mental health professionals to provide a joint, secondaryresponse to the scene.

1Introduction

Introduction

In recent years, law enforcement agencies across the country increasinglyhave collaborated with community partners to design and implement special-ized responses to people with mental illnesses. These agencies work closelywith mental health practitioners, people with mental illnesses and their fam-ily members, representatives of social service agencies, and others who sharetheir goal of improving the outcomes of encounters with people who havemental illnesses. Their specialized law enforcement–based response programsposition officers to safely manage these complex encounters and provide acompassionate response that prioritizes treatment over incarceration when

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Training: An Essential Element of a Specialized Response

Training is one of 10 “essential elements” of any specialized lawenforcement–based response program, according to a consensus ofexperts whose recommendations are captured in the report ImprovingResponses to People with Mental Illnesses: The Essential Elements of a Special-ized Law Enforcement–Based Program (a publication provided with supportby the Bureau of JusticeAssistance). Reflecting agreement among abroad range of policymakers, practitioners, advocates, and researcherswho work on these issues, the Essential Elements report states, “All lawenforcement personnel who respond to incidents in which an individ-ual’s mental illness appears to be a factor receive training to prepare forthese encounters; those in specialized assignments receive more com-prehensive training. Dispatchers, call takers, and other individuals in asupport role receive training tailored to their needs.”

To learn more and download a copy of the report, visitwww.consensusproject.org/issue-areas/law-enforcement.


appropriate. While variation exists among agencies with these programs,they share a common feature: officers who respond to incidents involvinga person with a mental illness receive extensive training for this role.

Training enables law enforcement personnel to perform duties requiredfor an effective response. With training, responders better understand men-tal illnesses and the impact of those illnesses on individuals, families, andcommunities. They are also better prepared to identify signs and symptomsof mental illnesses; utilize a range of stabilization and de-escalation tech-niques; and act in full awareness of disposition options, communityresources, and legal issues, all of which vary by jurisdiction. Supervisory andsupport personnel (such as midlevel managers, field training officers, calltakers, and dispatchers) also receive training that enables them to assistresponders and facilitate the specialized program’s operations.

While experts agree that training is acore feature of a specialized response pro-gram, they also caution that it presentscomplex challenges. As many practitionersexperienced in these law enforcement pro-grams know, training must do more thaninform its participants—it must also trans-form them. To perform effectively in theirnew role, officers need to acquire a greaterunderstanding of issues and systems withwhich they may have little familiarity; withthis base, they must also master new skillsthat will enable them to make safe andappropriate decisions during difficult andoften tense field encounters.

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“One of my CIT officers wasproud of her ability to calm aperson in crisis in her patrol carby turning the radio to an easylistening station.We don’tteach that specific tactic, butthe CIT training nurtures a levelof performance in the field thatbrings about a change in theculture of police.”

—major sam cochranCIT Coordinator, Memphis (Tenn.)Police Department


3Introduction

Many jurisdictions currently implementing specialized response pro-grams are finding that developing an effective training program is an itera-tive, time-consuming process that requires patience, commitment, andcooperation among partners. This guide is meant to facilitate this process bysharing lessons from the field, while recognizing that agencies may need totailor successful strategies from another jurisdiction to meet their uniqueneeds. Personnel who are planning training for a specialized response pro-gram can learn much from the experiences of those who have already over-come significant challenges.

About This ReportThis training resource guide is written for law enforcement personnel andstaff at other agencies who are planning a training initiative that will supporta crisis intervention team, co-response, or other type of specialized lawenforcement–based response program, as well as for individuals looking toenhance an existing training initiative. The guide reviews common chal-lenges experienced by several jurisdictions that have developed training forofficers encountering people with mental illnesses, and synthesizes the keylessons they learned that could be of benefit to others. To describe these chal-lenges and identify effective strategies for addressing them, the authors con-ducted field surveys, phone interviews, focus groups, and an analysis of theexisting literature on law enforcement training.2

The guide will be most useful to stakeholders in jurisdictions that are inthe process of developing a training program or want to enhance an existingtraining effort; the authors hope readers will find it a helpful companion toany training curriculum.3 It considers questions such as which individualswould be most appropriate serving as trainers for this type of effort, howthese trainers can be identified, what preparation trainers require, what tech-niques are most effective, and how planners can achieve maximum impactthrough these techniques. It is not a “how-to” guide for crafting individualcurriculum modules; rather, it provides direction on how to overcome spe-cific challenges that will likely come up during the development or improve-ment process of most training efforts. In other words, the discussion herefocuses less on which topics should be taught and more on how they can betaught most effectively.4 Several resources (see appendix C: CurriculumResource List) are available to assist communities in the critical step ofidentifying and tailoring curriculum content to address specific jurisdictioncharacteristics (e.g., mental health laws, mental health resources, and lawenforcement policies). The process of customizing training to local and

2. See the acknowledgments for a list of experts interviewed for this guide.

3. Throughout this document, the term “stakeholders” is used to describe the diverse group of individualsaffected by law enforcement encounters with people with mental illnesses, such as criminal justice andmental health professionals; numerous other service providers, including substance abuse treatment coun-selors and housing professionals; people with mental illnesses and their loved ones; crime victims; andother community representatives.

4. For a list of potential training topics for coordinators who are in the early stages of curriculum develop-ment to consider, see appendix B: Suggested Training Topics.


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regional needs, as well as decision making related to the duration and fre-quency of training, and how to pay for instruction, should be handled by amultidisciplinary committee tasked with creating a training plan that bestprepares officers to provide specialized responses.

This guide to training strategies will be most useful for jurisdictions inwhich a solid foundation for training is in place—in other words, when thefollowing steps have been taken:5

• Relevant organization and agency leaders, as well as other individualsinvolved in law enforcement encounters with people with mental ill-nesses, are committed to working together to develop a collaborativeresponse.6

• These leaders have formed a multidisciplinary planning committee todiscuss all issues related to program planning, including training.

• The planning committee has analyzed their community’s problems andavailable resources to inform the specialized program’s policies and prac-tices, which form the basis of the training content.

• The planning committee has determined whether some or all personnelin the law enforcement department should be trained and whethertrained officers should respond alone or in combination with mentalhealth providers.

• Agency leaders serving on the planning committee have designatedappropriate staff to compose a working group (called a coordinationgroup in this document) responsible for the day-to-day managementof personnel training and other program responsibilities.7 The coordina-tion group, which serves as the administrative body for the training initia-tive, has determined the length and frequency of training, developed thecurriculum, and made key recommendations, such as how to financetraining.

The coordination group—members of which are called coordinatorsthroughout this guide—will also oversee identifying and preparing trainersand selecting training techniques. More than any of the other individualsinvolved in a specialized law enforcement–based response to people withmental illnesses, coordinators are perhaps the group most likely to benefitfrom the recommendations provided in this guide.


5. The steps outlined here for creating a collaborative foundation for designing and implementing atraining initiative are culled from Improving Responses to People with Mental Illnesses: Essential Elementsof a Specialized Law Enforcement–Based Program, available at www.consensusproject.org/downloads/le-essentialelements.pdf.

6. In addition to the lead law enforcement agency, partners should include mental health service providersand consumers, their family members and loved ones, and advocates. Based on the nature of the problemin the community, additional partners might include other area law enforcement professionals; health andsubstance abuse treatment providers, housing officials, and other service providers; hospital and emer-gency room administrators; crime victims; other criminal justice personnel such as prosecutors and jailadministrators; elected officials; state, local, and private funders; and select community representatives.

7. In some jurisdictions the planning committee and the coordination group may be the same—particu-larly in those with small agencies, in rural areas, or with limited resources.


Introduction 5

Who’s Who in the Training Initiative

A training initiative to improve the law enforcement response to people withmental illnesses involves experts from a variety of disciplines who serve a rangeof functions.To differentiate among the various roles in the training initiative,this guide uses the following terminology:

• Coordinators—Representatives of the law enforcement agency and otherstakeholder groups who plan and oversee the training initiative. (Trainingcoordinators often also oversee other administrative aspects in a special-ized response program.) Responsibilities include identifying and preparingtrainers, designing the curriculum, selecting training techniques, andman-aging logistics.

• Trainers—Content experts who provide classroom instruction.Trainers canbe officers who teach policing functions, mental health professionals whodiscuss mental health-related topics, other justice or health professionalswho explain related legal concerns or substance abuse issues, or commu-nity members who describe what it’s like to live with a mental illness. (Seechapter 1 for an overview of trainers and training topics.)

• Role Players—Individuals who perform in the role of a person with a men-tal illness or another individual whomay be involved in the law enforce-ment encounter during the role play exercise. Role players can come from avariety of backgrounds: they may be professional actors, law enforcementofficers, mental health professionals, or consumers.8 (See chapter 3 formore on the role player’s responsibilities and considerations for findingrole players.)

• Facilitators—Individuals with experience in law enforcement responses topeople with mental illnesses who provide instructions and lead debriefingconversations during the role play exercise and other experiential learningactivities. (See chapter 3 for more on the role of the facilitator.)

• Participants—Law enforcement officers and other appropriate support per-sonnel who receive training to improve their response to people with men-tal illnesses. (Because the primary focus of this guide is improving lawenforcement responses to people with mental illnesses, recipients of cross-training other than law enforcement officials—that is, mental health pro-fessionals, consumers, and other stakeholders—are not included in thiscategory.)

These roles are notmutually exclusive: the coordinator may also serve astrainer; the facilitator as role player; or the coordinator as trainer, facilitator,and role player.The authors of this guide use specific terms to distinguishamong these different functions, while recognizing that multiple functionsmay bewithin a single person’s responsibility.

8. In the mental health system, “consumer” is the termmost frequently applied to a person who has receivedmental health services. The term is sometimes usedmore generically to refer to anyone who has a diagnosisof a mental illness.


LookingAheadThis document is organized into two parts, as outlined below.

Part One: Effective Trainers

Chapter 1 – Identifying TrainersProvides strategies for recruiting and selecting the most effective trainers.

Chapter 2 – Preparing to Teach a Law Enforcement AudienceDiscusses important approaches to teaching content related to mentalillness that meet the unique needs of law enforcement personnel andis sensitive to the policing culture.

Part Two: Effective Training Techniques

Chapter 3 – Enhancing Skills: The Role Play ExerciseProvides guidance on how to use role play exercises effectively, includinghelping officers to master essential de-escalation techniques.

Chapter 4 – Increasing Awareness: Site Visits, Testimonials, and SimulationsIllustrates how less traditional law enforcement training options can helpofficers better appreciate both the difficulties faced by people with mental ill-nesses and their family members, and the way mental health treatments andsupports are provided in their community.

Each chapter lists a set of challenges that jurisdictions have faced inimplementing a training initiative, followed by recommendations for anddiscussions of how they can be addressed.

To ensure that this guide is grounded in practical approaches, it includesexperts’ words of advice, examples of programs illustrating key themes, andreferences to supplemental resources.9 Excerpts from the Essential Elementsreport referenced above are also included to draw the connection betweentraining and key policies and practices that can improve how law enforce-ment responds to people with mental illnesses.

Strategies for Effective Law EnforcementTraining6

9. Agency representatives interviewed for this guide are quoted throughout the text. These experts repre-sent the various disciplines and perspectives found within the advisory group referred to in the acknowl-edgments and within the complete advisory board in appendix A.


Part OneEffective Trainers


Officers who provide the first response to people with mental illnessesrequire a broad understanding of relevant issues and a range of skills toperform the unique responsibilities of their assignment. This trainingshould be taught by experts whom officers will find credible. The followingsections discuss challenges planners and coordinators often experience

Chapter OneIdentifying Trainers

Broad Topics, Broad ExpertiseTraining for law enforcement officers on effective responses to people with mentalillnesses must draw on a diverse range of expertise and perspectives to cover abroad range of topics, from recognizing signs of mental illness to understandingthe state’s emergency evaluation laws. Many of these topics may be better taughtby experts from disciplines other than law enforcement. Trainers from the follow-ing categories can be helpful in presenting particular topics:10

• Law enforcement trainers can provide instruction on all matters related to firstresponse and other policing functions, including officer safety, scene stabiliza-tion and de-escalation skills, the need for a specialized response, procedures fortransporting an individual to a mental health facility, and the relevance of otheragency policies and procedures.

• Mental health practitioners can teach officers to identify signs and symptomsof mental illness and provide information about disposition options and com-munity resources—including advising officers about a drop-off facility’s policiesand admissions criteria (for example, its hours of operation, whether it acceptsindividuals with co-occurring substance use disorders, and limitations oncapacity).

• Consumers and family members can provide a face and a voice for people strug-glingwithmental illnesses.They can convey to officers the impact ofmental ill-ness on individuals, families, and communities.They are also uniquely qualified topromote a compassionate response from officers who often see peoplewithmen-tal illnesses onlywhen these individuals are in crisis.

• Other criminal justice and health professionals—such as mental health courtteammembers, jail administrators, and emergency room administrators—canpresent relevant legal issues, their interactions with law enforcement, and dis-cuss how the high numbers of people with mental illnesses affect their system.

Effective Trainers8

10. The involvement of particular trainers will largely be determined by the topics selected, the means for pre-senting them, and the need for more specialized training for individuals who will primarily respond to these callsfor service. For example, a department may decide to use an online training resource for ensuring that all officershave a baseline understanding of the signs and symptoms of mental illness but then also bring in mental healthprofessionals to help guide interactive group training sessions for advanced instruction for CIT officersor others acting in a specialized response assignment.


when identifying and selecting trainers most appropriate for this initiativeand then offer various strategies that have been successful in overcomingthese challenges.

Challenges

• Few law enforcement agencies or their training programs will have theinternal capacity or expertise to teach the entire range of topics that firstresponders require when working with people with mental illnesses.Agency training planners or coordinators may also lack familiarity withqualified experts in the community who can adapt material to a lawenforcement audience.

• Not all communities will have an adequate pool of local experts whocan provide aspects of this training to officers. Planners or coordinatorsmay have additional difficulty identifying outside instructors with exper-tise in any of the relevant topic areas who have observed a significant num-ber of law enforcement encounters with people with mental illnesses orare familiar with policing culture, policies, and the everyday demandsofficers face.

• Some agencies will lack the funds to coordinate a training initiative,including expenses related to contracting with trainers.

• Trainers who have had negative encounters—whether from the lawenforcement or mental health perspective—may find that those experi-ences color their presentations and pose significant barriers to effectiveteaching, even if the instructors are motivated to help improve lawenforcement interactions.

Effective Strategies

� Develop in-house expertise to teach law enforcement topics.

If a law enforcement agency is at the beginning stages of implementinga specialized response program, it is unlikely to have personnel prepared toteach policing strategies that are unique to encounters with people with men-tal illnesses. Relying on outside experts to train all specialized responders orsending all officers to train in other jurisdictions can be costly and may notbe as efficient as developing in-house expertise—particularly if this requiressignificant travel out of the region.

A train-the-trainer course that includes a large number of trainers—either from within the agency or along with trainers from nearby agencies—is an ideal way to develop a pool of law enforcement training experts. Thiscourse can be taught as a one-time offering by outside experts. Alternatively,an agency can identify officers to serve as training coordinators and sendthem to another jurisdiction with an active specialized response program

9Chapter One: Identifying Trainers


and ongoing trainings.11 When they visitanother community’s program, lawenforcement training coordinators shouldask questions about its development, collectmaterials, and develop expertise on thetopic. Many agencies have sent officers tojurisdictions with long-established andprominent specialized response programs(such as Memphis, Tenn.; Akron, Ohio; andAlbuquerque, N.Mex.). Some states—including Colorado, Georgia, Illinois, Ohio,and Utah—have established train-the-trainer centers that offer instruction to allagencies in that state.12 These officers then tailor and supplement the train-ing they have received to reflect the unique needs and resources of their owncommunity.

Because the officer, or group of officers, who teaches law enforcementtopics will likely become the agency’s primary source of authority on thistopic, the individual(s) should have significant experience in patrol andshould be respected throughout the agency and community. In many com-munities, these officers will coordinate the specialized response program andtraining, represent the agency on the planning committee, and even chairthat committee.

� Work with partners to identify trainers outside thelaw enforcement agency.

Law enforcement coordinators might not know who would be a good fitto teach modules such as recognizing symptoms of mental illness and strate-gies for officers to use when mental illness appears to be a factor in the callfor service. Training coordinators will need to reach out to respected commu-nity partners—especially groups and individuals representing mental healthprofessionals, consumers, and family members—to collaborate on identify-ing trainers or facilitators.

Members of the training coordination group from diverse disciplinesand perspectives should identify individuals who can speak with authorityabout particular topics. Representatives from mental health agencies can taptheir staffs’ networks and consult with the local mental health board or rele-vant faculty at nearby universities for recommendations. Coordinators canalso contact nearby jurisdictions to learn whom they have used as trainers.Advocacy organizations, such as NAMI (National Alliance on Mental Illness)

“One of the tougher parts of thetraining is teaching officers totake a different approach tohandling someone who is men-tally ill. It is best to have arespected law enforcementofficer discuss that portion.”

— dr. risdon slateProfessor of Criminology,Florida Southern College,and consumer of mentalhealth services

Effective Trainers10

11. To search for programs with training initiatives in your area, see the Criminal Justice/Mental HealthInformation Network, available at www.cjmh-infonet.org and coordinated by the CSG Justice Center.

12. To learn more about the efforts of the Colorado Regional Community Policing Institute, seewww.dcj.state.co.us/crcpi/CIT.htm; the Georgia Bureau of Investigation, see www.state.ga.us/gbi/CIT/index.html; the Illinois Law Enforcement Training and Standards Board, see www.ptb.state.il.us/training/training_main.htm; the Ohio Criminal Justice Coordinating Center of Excellence, see www.neoucom.edu/CJCCOE; and the Salt Lake City Police Department, see www.slcpd.com/insideslcpd/statewidecit.html.


and Mental Health America (MHA), both of which have local affiliatesnationwide, or local mental health clinicians can help identify consumersand family members to participate in question-and-answer panels or otheraspects of training.13 Coordinators can also approach psychiatrists, who canask their clients if they are interested in participating in such an initiativeand, if so, for permission to pass along their contact information to the coor-dination group.

Training coordinators can then select trainers from the pool of nomi-nees. Even in communities where the ultimate decision about who will teachis made by the lead law enforcement agency, this process makes use of theexpertise of partners to identify highly qualified trainers from a broad rangeof disciplines.

� Coordinate trainings with other area law enforcementagencies to share trainers and reduce overhead costs.

The cost associated with training can be significant. Although partneragencies and community members will often volunteer time or services tohelp reduce expenses that would otherwise be charged to the law enforce-ment agency, some costs are inevitable. Law enforcement agencies mustoften pay overtime both for officers receiving training and for other officerswho cover their assignments. Preparing materials, renting space and equip-ment, and paying for meals are just some of the other potential expenses. Ifa community has to bring in outside experts, their travel and contractor feescan also contribute to a significant budget strain.

Coordinators may consider conducting training along with other lawenforcement agencies in the region to share trainer(s) as well as associated

Excerpt from theEssential Elements report

“Organizations and individuals repre-senting a wide range of disciplinesand perspectives and with a stronginterest in improving law enforce-ment encounters with people withmental illnesses work together in oneor more groups to determine theresponse program’s characteristicsand guide implementation efforts.”

Application tospecialized training

The coordination group bringstogether the lead law enforcementagency, mental health serviceproviders andmental health con-sumers, family members and lovedones, advocates, and other relevantgroup representatives. It creates aforum for collaborative planning forthe training initiative.

11Chapter One: Identifying Trainers

Essential Element: Collaborative Planning and Implementation

13. NAMI, a grassroots mental health advocacy organization, has local affiliates in all 50 states. To identify aNAMI affiliate in or near your community, visit www.nami.org/Template.cfm?section=your_local_NAMI.To find an MHA affiliate, visit www.nmha.org/go/searchMHA. (MHA was formerly known as the NationalMental Health Association or NMHA.)


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expenses. A host agency will generally coordinate the training, and neighbor-ing agencies will send personnel and offset costs with contributions—eitherin-kind or in the form of registration fees. This model works particularly wellin rural or other areas in which multiple law enforcement agencies worktogether to provide a specialized response across several jurisdictions thatshare a single mental health treatment facility.

Coordinators can work to identify nearby jurisdictions that already con-duct regular training sessions on specialized responses and ask if places canbe reserved for their personnel. If none are known, coordinators can visit theCriminal Justice/Mental Health Information Network, which is coordinatedby the CSG Justice Center and available at www.cjmh-infonet.org. This on-line network allows users to search for program profiles by state, and pro-vides contact information for each program entry.14

� Select trainers who have an appreciation for the specializedresponse program’s goals, positive attitudes toward lawenforcement, and experience with people with mentalillnesses involved with the criminal justice system.

Training will be less effective when trainers’ past experiences or orienta-tion prompts them to make negative statements about the law enforcementagency or people with mental illnesses.Some or all members of the coordinationgroup should interview potential trainersto ensure that the instructors’ reasons forparticipating do not run counter to theprogram’s objectives and would not limittheir contributions or credibility. Althoughit may not be practical to conduct a rigor-ous application process for all potentialtrainers, it is important that coordinatorsare aware of trainers’ attitudes and level ofcommitment.

When the coordinating group selectsfamily members and consumers to partici-pate in the training, these individualsmust be familiar with interactions withlaw enforcement and have moved beyondany negative outcomes of those encounters. When the agency identifiessworn officers to assist in training as facilitators or in other functions,coordinators should ensure these officers have had sufficient practicalexperience encountering people with mental illnesses or dealing withcrisis situations and likewise are prepared to contribute in a constructive,positive manner.

Effective Trainers

“You must be careful to selectconsumers who have gottenpast blaming the police forwhat happened and can removethemselves from the past. Theymust be at a point in theirrecovery to talk openly abouttheir experiences in a way thatwill benefit the police.”

— dr. risdon slateProfessor of Criminology,Florida Southern College,and consumer of mentalhealth services

14. To find out which local jurisdictions are providing CIT training, see the CIT National Organizationwebsite, available at www.cit.memphis.edu/cno.html. Information on local CIT efforts can supplementinformation on co-response and other potential program models.


� Evaluate trainers to make programmatic decisions andprovide specific feedback.

To ensure that trainers are providing core substantive information in amanner that promotes successful learning, coordinators should monitor per-formance in the classroom. Evaluation can be conducted in a number ofways: coordinators can provide students with evaluation forms, debrief someor all officers informally after the training, or observe trainers in action. Thisinformation can be used to determine whether to retain a particular trainer,to provide feedback to enhance performance, or to broaden the search forfuture trainers.

LookingAheadIdentifying qualified experts to teach the various topics in a curriculum thatcovers law enforcement responses to people with mental illnesses is one keystep in a series of important efforts to develop effective training. Manyexperts on mental health–related topics will not have extensive experienceworking with law enforcement professionals. Law enforcement experts fromoutside the community may be familiar with the culture but unfamiliar withimportant community characteristics. The next chapter discusses ways toprepare the spectrum of trainers to coach law enforcement officers onimproved responses, while recognizing factors unique to a specific lawenforcement agency and jurisdiction.

Chapter One: Identifying Trainers 13


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Law enforcement officers may have concerns about their safety duringencounters with people with mental illnesses, their ability to control thesesituations, and their lack of experience performing nontraditional policingfunctions. To address these concerns, coordinators and trainers—particularlynon–law enforcement personnel—must understand and recognize the reali-ties of what officers encounter on the street and the demands put on them torespond to calls quickly and resolve situations safely. Many communitiesoffer train-the-trainers sessions to educate coordinators and trainers fromother disciplines on the challenges in and opportunities for training thisaudience. These sessions emphasize core themes about the policing cultureand describe proven techniques for training law enforcement professionalsin mental health topics.

This chapter discusses challenges that can arise when coordinators andtrainers have not been adequately prepared. It then offers strategies that oth-ers have found useful in improving the impact of their efforts. Though mostof the strategies are directed at people without law enforcement back-grounds, they are instructive for all coordinators who are looking to maxi-mize the impact of training on responses to people with mental illnesses.

Challenges

• Some officers may feel that non–law enforcement coordinators and train-ers, or even law enforcement instructors who have little patrol experience,do not fully appreciate the unique issues street personnel face. Some par-ticipants may also believe that people from other disciplines blame lawenforcement for any bad outcomes in encounters involving people withmental illnesses.

• Officers may have little or no background in mental health issues andmay find it difficult to translate tremendously complex information intoconcrete actions and procedures. As a result, participants may becomefrustrated or lose interest if the material is not clearly relevant or is pre-sented in dry, medical terms.

• As with many professions that serve the community as first responders,patrol officers receiving classroom training have to adjust from operating ata fast pace with regular direct engagement with others and a great deal ofdiscretion in their daily routines to long periods of instruction and relative

Effective Trainers

ChapterTwoPreparing to Teach a LawEnforcement Audience


inactivity. This is particularly true for those receiving advanced training inmental health issues, which typically consists of 40 hours of instruction—much of which occurs in a classroom.

• Trainers from outside the community may not be familiar with itsresources, relevant laws, and other local factors; similarly, some trainersor coordinators from the community may not be familiar with all the localsupports and other important information that is unique to the jurisdic-tion. Without this knowledge, instructors may recommend practices orapproaches that cannot be supported by the community.


� Involve experienced law enforcement personnel inmany aspects of the training.

Trainers’ understanding of policing, particularly street operations, isvital: if participants do not find trainers to be credible, they are less likely toaccept the training and implement the practices learned. An important wayto ensure that training reflects an aware-ness of law enforcement culture, policies,procedures, and real-life demands on thestreet is to involve experienced law enforce-ment personnel in many aspects of thetraining.

The law enforcement agency can iden-tify personnel to facilitate the training—whether a single officer or several trainedpersonnel. The officer(s) who go throughprior training—either in train-the-trainer sessions or by observing training inmore experienced jurisdictions—can assume this role. These officers shouldbe responsible for leading all modules related to policing functions, introduc-ing speakers, tying mental health content to experiences first responders arelikely to face, managing the role plays, and answering questions.

Other experienced officers can also be involved in supporting roles. Theycan explain the importance of this training in the field, provide assistance asrole players, and offer personal stories about family members or others whohave mental illnesses and are at greater risk of encounters with law enforce-ment. Some communities pair an officer with a mental health clinician forparticular modules, such as identifying symptoms of mental illness. In thisarrangement, psychologists or psychiatrists join experienced law enforce-ment responders in the presentation on crisis de-escalation: the mentalhealth professional describes symptoms of mental illness, and the lawenforcement responder discusses specific techniques for de-escalatingrelated behaviors.

Chapter Two: Preparing to Teach a Law EnforcementAudience 15

“These programs must be police-driven, and as such, there mustbe a strong police presence inthe training.”

— officer frank webbCIT Coordinator, Houston (Tex.)Police Department


16

� Connect non–law enforcement coordinators and trainerswith patrol officers and other policing personnel to increasetheir awareness of the law enforcement culture, the currentrealities of policing at the street level, and the complexity ofthese encounters for officers.

Content experts from outside the law enforcement agency may not haveextensive personal experience with law enforcement encounters with peoplewith mental illnesses. These experts may lack familiarity with the policingculture, policies, procedures, and real-life demands on the street. Similarly, ifa sworn law enforcement trainer has notbeen on patrol for many years, or has hadonly a brief experience in that assignment,participants may be wary of accepting thenew roles, approaches, and responsibilitiesput forth in training.

Non–law enforcement coordinatorsand trainers can improve their understand-ing of the demands, priorities, and con-cerns of the officers in the training byincreasing contact with street officersbefore training; for these coordinators andtrainers, this could involve participating incross-training opportunities. Ride-alongsprovide an excellent opportunity for allcoordinators and trainers to observe the current pressures on first respon-ders, as well as to develop relationships with particular officers. To help theseindividuals become more familiar with procedures, some agencies alsoarrange site visits to the department for non–law enforcement personnel.

� Establish a shared commitment to addressing the problem.

Non–law enforcement coordinators and trainers should emphasize thecommitment they share with law enforcement to improve officers’ encoun-ters involving people with mental illnesses. When stakeholders acknowledgethey have come together to solve a sharedproblem, the focus of the training is shiftedaway from assigning blame and squarelydirected at how service providers, con-sumers, family members, and officers cansupport one another in reducing calls forservice and handling encounters effectively.

Coordinators should ensure thatnon–law enforcement trainers are fullybriefed on the need to have their remarkshelp build bridges rather than widen gaps.Coordinators and trainers alike should describe their own positive experi-ences with law enforcement, and the impact those experiences have had onthem personally and professionally. The focus of this discussion should be

Effective Trainers

“Instructors should ride with anofficer for a shift to gain a bet-ter understanding of the natureof police work.When this hap-pens, it has been our experiencethat lesson plans change andbecome more [relevant] to anofficer’s workload.”

— lieutenant michaelwoody (retired)Law Enforcement Liaison, OhioCriminal Justice CoordinatingCenter of Excellence

“Family members can provideofficers with specific sugges-tions on how to enlist them inefforts to de-escalate the crisissituation.”

— ms. kate farinholtExecutive Director, NAMI-Metropolitan Baltimore, Inc.


on what officers can do, not on what theyshould have done. Mental health trainers, forexample, can be instructed to point out sev-eral steps officers can take that would helptheir clients when in crisis or examples ofsuccessful interactions and their impact.

To underscore common goals, coordi-nators and trainers should articulate whyimproving outcomes of law enforcementencounters with people with mental illnesses is important to them. Mentalhealth professionals can list available community supports and services, andprovide specific recommendations to help law enforcement officers referpeople to these community-based providers more efficiently.

Even law enforcement coordinatorsand trainers benefit from sharing with thegroup their commitment to improvingresponses to people with mental illnesses.They can communicate personal reasonswhy they believe an improved law enforce-ment response is needed, perhaps drawingon their concern for a family or communitymember with a mental illness who theyworry is at risk of encounters with officers.They can state from a practical standpointwhy enhanced responses can reduce callsfor service and provide better outcomes forall involved.

� Recognize and respect officers’ safety concerns.

Coordinators and trainers must be aware that officers’ first priority issafety—the safety of the public, the person involved in an encounter, them-selves, and their fellow officers. They should highlight how specialized train-ing helps protect all those involved in an incident. Non–law enforcementcoordinators and trainers should be partic-ularly sensitive to this issue: if they askofficers to do anything that is contrary totheir efforts to ensure safety, their credibil-ity will be lost. This does not mean thatinstructors should exaggerate the dangersof these encounters. They can use datafrom the participating agencies or otherdepartments to demonstrate how force israrely needed in the vast majority of theseencounters and to dispel the myth thatpeople with mental illnesses are prone toviolence.


“All [negativity] does is makethe officers more suspiciousof the program.”


“We coach our instructors to‘teach for success.’ They do thisby telling stories of successfulofficer encounters and by focus-ing on how the police can help.For example, we ask instructorsto identify two specific thingsthe police can do to help theirclients.”

— lieutenant jan olstadformer CIT Program Coordinator,Albuquerque (N.Mex.) PoliceDepartment

“We should market this programas an officer safety program.Although there are many pro-gram objectives (such as jaildiversion), our primary objec-tive is officer and consumersafety.”

— officer frank webbCIT Coordinator, Houston (Tex.)Police Department


18

� Use training techniques that engage officers.

Research suggests that adults learn best when challenged to learn fromtheir own experiences in a self-guided environment. Training for specializedresponses should include hands-on, inter-active activities—referred to in this publica-tion as experiential learning—and prepareexperts to moderate these activities.

Experiential learning techniquesrequire extensive planning—both conceptu-ally and logistically—to ensure that officers’experiences are positive and productive.Coordinators should learn about these dif-ferent techniques and support experts whohave a role in implementing them.

� Pose questions that prompt officers to consider theirown experiences in order to stimulate discussion.

To encourage officers to participate in the discussion, coordinators andtrainers should pose questions that engage the law enforcement audience by

Effective Trainers

“If you listen to me lecture, youwill get 2 percent of the infor-mation; if you take notes, youwill remember 5 percent; but ifit’s hands-on, [you] will neverforget it.”


Experiential Learning and Training TechniquesEducators often use the term “experiential learning” to refer to struc-tured activities designed to enable students to learn through experi-ence. In law enforcement training to improve responses to people withmental illnesses, coordinators have found several techniques particu-larly effective in enabling experiential learning.

Role plays—Exercises providing officers individualized practice tohelp acquire and reinforce new skills in de-escalation and crisis inter-vention in a classroom environment that simulates real-world condi-tions (discussed in chapter 3).

Site visits—Travel to facilities where participants can observe andmeet with practitioners and patients at inpatient treatment facilities,community-based crisis centers, and consumer support programs (dis-cussed in chapter 4).

Consumer and family member testimonials—Presentations inwhich one or more individuals with mental illness or their family mem-bers discuss their personal experience living with a mental illness, pro-viding an opportunity for officers to ask questions (discussed inchapter 4).

Simulation exercises—Learning through the use of multimediadevices that mimic various symptoms of mental illnesses. The mostcommon simulation tool for mental illness symptoms is the HearingVoices ThatAre Distressing program, which exposes trainees to the effectsof continuous and often unpleasant voices (discussed in chapter 4).


calling upon officers’ practical experiences and knowledge. For example, theymay ask:

• What types of calls frustrate you?

• Are there calls that have not been han-dled as well as they could have been?

• What types of calls have you dealt withthat had poor outcomes?

• What calls have you handled in whichyou felt you needed better options?

• What are your success stories? What hasgone well?

� Use language with which officers are familiar.

When discussing mental illnesses, coordinators and trainers frommedical and mental health professions and people with mental illnessesand their family members should avoidoverusing clinical terminology or diag-noses. Instead, content should be presentedin clear terms and focus on behaviors thatofficers are likely to observe. Similarly,coordinators and trainers should avoid pre-senting too much information or detail thatis not directly relevant to a law enforcementofficer. Some communities also provideinstructors with appropriate law enforce-ment terminology, such as the code forcalls in which a person’s mental illnessappears to be a factor.

� Offer frequent breaks, and stagger the “inactive” sessions.

For some topics, a more traditional, lecture-style instruction will benecessary. Coordinators should schedule short breaks throughout theselessons—as many as 10 minutes of break time for every hour of materialtaught. Coordinators should also structure the agenda to stagger these typesof sessions across the training program.

� Ensure that trainers are familiar with community resources,characteristics, local limitations on law enforcementauthority, and other factors unique to the jurisdiction.

Provide trainers with a “community service inventory” that includes infor-mation about what mental health supports and services are available in thecommunity, how and when law enforcement can access these services andwhat treatments or supports they offer to which client groups. Coordinatorscan develop written materials that summarize this important background


“I have seen clinicians getbogged down in specific diag-noses and lose the officers’attention. The main thing isto present the [symptoms of]major diagnoses so officersknow when they need to getthe person to a clinician.”

— dr. risdon slateProfessor of Criminology, FloridaSouthern College, and consumerof mental health services

“The key to an effective class isinvolvement—if the officers aretalking, you know they areinvolved. To get them talking,instructors must ask the rightquestions.”

— officer joan loganCIT Coordinator, MontgomeryCounty (Md.) Police Department


20

information, provide trainers with opportunities to visit facilities and meetwith relevant stakeholders, or do a combination of these. They can also workwith trainers to adapt general materials and content to the needs of the agen-cies represented at the training. Information on any legal authorities that gov-ern law enforcement’s involvement should also be included.

LookingAheadSpecialized training should energize officers to improve their responses topeople with mental illnesses. High-quality, well-prepared trainers are essen-tial to any program’s success. Equally important, the training must engage itsparticipants with hands-on lessons that provide an opportunity to practicenew skills. The upcoming chapters discuss strategies for successfully imple-menting four common and effective experiential learning techniques.

Effective Trainers


PartTwoEffective TrainingTechniques


22

Responding effectively to calls involving people with mental illnesses oftenrequires that officers take a nonaggressive posture and not rush toward a res-olution that can escalate the situation. To address the needs of people withmental illnesses, officers may have to learn new strategies that depart fromtheir recruit training, which generally emphasizes the need to take control ofa situation and address the call quickly.

One of the key objectives for specialized law enforcement responsetraining programs is to enhance officers’ de-escalation and crisis interventionskills by providing structured opportunitiesto practice those skills. Experts agree thatrole play exercises are an indispensable partof a training initiative that focuses onimproving responses to people with mentalillnesses. This technique, used for manyexisting law enforcement training topicsfrom academy to in-service training, helpsofficers acquire and practice the strategiesthat form the foundation of an effectiveresponse.

Effective Training Techniques

ChapterThreeEnhancing Skills:The Role Play Exercise


“Specialized law enforcement respon-ders [must] de-escalate and observethe nature of incidents in whichmen-tal illness may be a factor using tacticsfocused on safety. Drawing on theirunderstanding and knowledge of rele-vant laws and available resources, offi-cers [should] then determine theappropriate disposition.”

Application tospecialized training

Specialized training provides officerswith the ability to identify signs andsymptoms of mental illness andemploy a range of stabilization andde-escalation skills (among othertechniques). Role plays are a criticaltool that allows officers to practiceand retain these skills in a structuredand safe learning environment,where they can receive constructivefeedback before applying the skills inthe field.

“Officers are usually trained tobe aggressive and physicallycommanding, but these areproven to be the worst tech-niques to use in most encoun-ters with a person who ismentally ill.”

—officer frank webbCIT Coordinator, Houston (Tex.)Police Department

Essential Element: Stabilization, Observation, and Disposition


Challenges

• Because role plays are based on performances in which individuals actingout parts (role players) adapt their behavior based on participating officers’actions, they involve a certain amount of improvisation. Some agenciesmay be concerned that role plays will stray from the primary purpose ofthe training.

• Effective role plays must mimic real-life situations, which can often bevolatile. Agencies may have concerns that role plays will result in unpre-dictable and potentially out-of-control behavior.

• Some officers may be wary about the amount of attention they will receivewhen their peers are observing their participation in the exercise.


� Identify facilitators.

Strong facilitation is integral to ensuring that role play exercises rein-force acceptable techniques in the core training topics and keep the sessionon track. Many communities include several facilitators: law enforcementpersonnel who can critique policing techniques (for example, some commu-nities use field training officers as facilitators) and clinicians who can adviseofficers on identifying symptoms of mental illness. The law enforcementfacilitator can also coordinate the overall training on behalf of the lawenforcement agency (which includes representing the agency in the coordi-nating group) and can provide training inde-escalation skills.

Facilitators help set the tone and pace,and they can stop the role play (call a “time-out”) to offer advice or forestall actions thatseem to be leading toward unproductive orunsafe resolutions. They lead debriefingdiscussions and guide individuals who arerole playing to ensure that their perform-ances are most effective. A facilitator mayalso serve as the role player in the exercise,although some coordinators prefer to keepthese functions separate to enable the facili-tator to concentrate his or her efforts onthat critical role.

� Ensure safety and avoid distractions.

Departments may be wary of using role play exercises because they aretime-consuming and sometimes unscripted or unpredictable. Strong facilita-tion helps keep the role play focused and productive and can minimize these

Chapter Three: Enhancing Skills: The Role Play Exercise 23

“If the facilitator doesn’t likewhat the actor or officer isdoing, he or she takes a time-out. The officer may be tooauthoritative or is stuck usingthe same tactic repeatedly. Thefacilitator can point out addi-tional strategies or proposeideas for how to proceed.”



24

concerns. Experts also reiterate the impor-tance of avoiding anything that may makethe role play unsafe or divert it from thetopic.

For this reason, coordinators shouldcarefully consider whether to includeweapons in the scene. Some experts feelthat weapons present a significant distrac-tion from the focus on assessing mental ill-ness and can even result in injuries to role players if the situation wouldwarrant a tactical response from officers. Other experts believe that realism isof the utmost importance and include stage weapons to fully prepare officersfor what they may encounter. In spite of these differences of opinion, expertsdo agree that hidden weapons should never be included, and that facilitatorsmust be quick to call a time-out if the exercise appears to be potentiallyunsafe for anyone involved.

Involving other complex factors in the scenario, such as domestic vio-lence, can also be distracting. These additional factors sometimes require dif-ferent sets of skills and approaches and can interfere with the primary focuson improving how to assess and de-escalate behaviors that seem to stemfrom a mental illness. Coordinators should carefully consider which simu-lated scenarios will best address the primary goal of the training.

� Schedule role plays so they follow importanttraining topics.

As an exercise designed to draw on newly acquired information andskills, the role play should come toward the end of the curriculum, so thatofficers can use all they have learned. In particular, officers can apply theiracquired ability to recognize signs and symptoms of mental illness and thendetermine how to address behaviors and make disposition decisions. Toenhance these skills, coordinators can instruct role play actors to present dif-ferent behaviors described earlier in thecurriculum. Based on their observations,officers can then use de-escalation skillsand determine an appropriate outcome forthe person (for example, arrest, referral, oremergency evaluation). Afterward, the facil-itator can ask participants to describe whatbehaviors indicated that mental illnessmight have been a factor in the incidentand why they made their decisions forresolving the encounter as they did.

� Keep the exercise focused on the primary goals ofthe training.

To enhance the quality of the role play, the facilitator should makeclear to officers what the specific goals are to help them learn how to collectinformation to determine whether mental illness could be a factor in the


“The key to role plays is to notlet them get out of hand and tonever hide weapons. Once youthrow a hidden gun into thescenario all bets are off.”

—officer joan loganCIT Coordinator, MontgomeryCounty (Md.) Police Department

“[Role play] is really the test tosee what the officers havelearned throughout the trainingas well as a way to practicelearned skills.”



situation, to resolve the incident safely, and (if appropriate) to initiate aprocess for connecting the person with voluntary treatment. Some communi-ties’ training coordinators emphasize role play goals before the exercise usinghandouts; some even refer to goals during the exercise by calling time-outsand offering verbal guidance.

Some communities have found that using a script is also a useful wayto reinforce consistent themes and to ensure that role players stay “on mes-sage.” Scripts or scenario descriptions should set the stage by providinginformation on the characters and location; for example, officers may be toldthat a family member is in another room and should be taken into accountin the officers’ response. These scripts are generally drawn from actual inci-dents involving officers and people with mental illnesses, which ensurestheir practicality and increases the credibility of the technique.

� Debrief officers after role plays are complete.

Coordinators and facilitators shoulddevelop a process for debriefing all partici-pating officers following the exercise. Thisevaluation will help officers reflect on thesuccesses and failures the group experi-enced. The law enforcement facilitatorshould lead the debriefing to focus on thelessons learned about de-escalation tech-niques and maintaining safety; some com-munities also invite role players and mentalhealth practitioners to provide their obser-vations. The debriefing is another opportu-nity to draw connections between the roleplays and other content in the training(such as cultural sensitivity and legalissues).

� Provide sufficient opportunity for each officer toparticipate.

Because of the importance of role plays, enough time should be allottedso that each officer has an opportunity to engage in the activity and receivefocused, one-on-one feedback. Groups should be kept to a manageable sizeso that each officer can spend a minimum of 10 to 15 minutes practicingde-escalation skills.

In some communities, the exercise involves only one officer (not includ-ing role players and the facilitator); in others, one officer is initially involvedin the exercise, and others are cycled in until the facilitator determines thatthe simulated situation has been effectively resolved. Other communities use“contact and cover” scenarios, in which one officer engages the individualwho appears to have a mental illness while another provides backup; eachofficer has a turn in both roles. Generally, officers sit in a circle surroundingthe officer(s) participating in the exercise. The facilitator provides generalobservations to ensure that these officers learn from their peers’ training.


“In Baltimore City’s training, apolice training officer providesa short debriefing immediatelyafter individual role plays.When all role plays are com-plete, the officers meet for amore in-depth debriefing.Atthe larger debriefing, role play-ers and training officers candiscuss negatives and positivesoverall, without namingnames.“

—ms. kate farinholtExecutive Director, NAMI-Metropolitan Baltimore, Inc.


26

� Encourage officers to get the most out of the exercise.

As with any class setting, some participants may be less eager than oth-ers to receive individualized attention and scrutiny in front of their peers.Facilitators can offset participants’ reticence by emphasizing the exercise’simportance and its usefulness as the bestway for officers to ensure their prepared-ness in future encounters with people withmental illnesses. When providing feedback,facilitators should offer encouraging andconstructive comments and never embar-rass individual officers. Facilitators shouldalso urge officers to pay close attentionwhen their peers are the subject of theactivity.

� Select role players who can enhance the reality of thescenario and provide consistency across trainings.

The success of a role play exercise largely depends on the person who isrepresenting the person with a mental illness. This individual must be ableto portray real-life situations convincingly and react to the officer in a waythat either positively or negatively reinforces the officer’s behavior during thescenario. For example, if an officer is standing with his or her arms crossed,the person playing an individual with a mental illness should escalate the cri-sis behavior to negatively reinforce that behavior. Alternatively, if the officertalks in a soft voice and maintains a proper distance, the person in the role ofthe individual with a mental illness should respond positively by de-escalat-ing his or her crisis behavior.

This sensitivity requires extensiveexpertise and experience on the part of therole player. In spite of the critical role ofthese actors, no consensus exists regardingwho should be called upon to fill this posi-tion. To a large degree, the variations thatcommunities report are based on local cir-cumstances and available resources. Insome communities, professional actorswho specialize in clinical scenarios areavailable. Most, however, do not have thisresource, or the money to pay for it, andinstead may use other law enforcement officers (including the role play facili-tator), mental health professionals, consumers, or others as role play actors.While community resources will often determine the program’s role playeroptions, planners and coordinators should nonetheless be aware of thestrengths and weaknesses of different types of role players and preparethem extensively for their parts. (The chart on page 27 describes advantagesand perceived limitations of different types of role players.) In addition tocoaching role players on adapting their performance based on an officer’s


“Once even the most resistantofficer goes through this phaseof training, he or she will give itthe highest praise of all.”


“We don’t use consumers in roleplays because I see this asanother opportunity to nurturethe CIT officers.When we useCIT officers in the role plays itinstills in them a way to nur-ture their program and haveownership over it.”




Role PlayersCommunities have explored different options for role play actors. The table below identifiesthe four most common types of role players, communities in which they provide this role, andcommonly perceived strengths and weaknesses as role players.15

Role play actor Example AdvantagesGeneral perceptionsof limitations

Trained actors16 Akron (Ohio) CIT:The pro-gram uses “standardizedpatient actors” from theNortheast Ohio UniversityCollege of Medicine.Theseactors are typically used totrain new doctors in role playsduring their residencies.

Can play the same rolerepeatedly

Trained to modify behaviorbased on positive and nega-tive cues from respondingofficers

Potentially unfamiliar withlaw enforcement procedures

Limited perspective on livingwith mental illness

Law enforcementofficers

Memphis (Tenn.) CIT:The training coordinatoridentifies veteran CIT officerswho themselves have beenthrough CIT training and arewell suited to perform thisfunction.

Experienced officers whohave been in many such inci-dents can recall the behaviorof people with whom theycame in contact

May feel more comfortablemakingmistakes in thepresence of other officers

Limited perspective on livingwith mental illness

May lack training in modify-ing behavior positively ornegatively based on cuesfrom responding officers

Mental healthprofessionals

Montgomery County (Md.)CIT: Licensed staff therapistsfrom theMental Health CrisisCenter role play people withmental illnesses. These thera-pists are frequently called tothe scene by responding offi-cers and are therefore famil-iar with law enforcementprocedures.

Highly familiar with signsand symptoms of mentalillness

Uses professional expertiseto help focus the exerciseand ensure that it coverscore training topics

Potentially unfamiliar witha range of law enforcementprocedures

May be overly focused onevaluating officers’ under-standing of clinical aspectsof their performance

Consumers/family members

Chicago (Ill.) CIT: The pro-gram uses actors who them-selves have a mental illness toplay the parts of family mem-bers and consumers. Theseactors are part of theThresh-oldsTheatreArts Project.17

Have direct personal involve-ment with mental illness

May have had contact withlaw enforcement

Involvement can provokea negative response that canbe a catalyst for a setback inrecovery

Officers may be less comfort-able in a training environ-ment with real-lifeconsequences

15. General perceptions of limitations of different types of role play actors were collected from interviews with practitioners, trainers,and other sources and do not necessarily reflect the views of the agencies listed.

16.The Crisis Company provides professional role play services to law enforcement agencies with CIT programs.The Crisis Companyemploys professional actors who are trained to accurately portray adults and children in crisis and/or with mood, thought, or person-ality disorders. Information about this organization is available at www.crisiscompany.com.

17. For more information on this project, see www.thresholds.org.


28

mannerisms and approach, facilitatorsmust instruct them to never touch the offi-cer during the role play, as officers who aretrained to respond forcefully to such con-tact may react accordingly.

LookingAheadIn addition to equipping officers with newskills, specialized training should provide them with a broader perspective onmental illness. This information will prove instrumental for officers whende-escalating incidents involving a person with a mental illness and deter-mining and implementing an appropriate disposition to the incident. Thefollowing chapter discusses how training can provide officers with a windowinto living with mental illness, as well as when and how to gain better accessto a mental health system that can provide long-term alternatives and reducecalls for service.


“We think people who work inthe crisis field who know whatmental illness looks like shouldbe playing the key role of con-sumer and family members.”



Training for specialized law enforcement–based response programs mustimprove officers’ understanding of mental illness and its impact on individu-als and their families, offer strategies for connecting people to mental healthservices when appropriate, and promote an appreciation for how service pro-vision works. Several experiential learning activities can help accomplishthese goals. Cross-training opportunities, such as site visits, ensure that offi-cers are briefed on mental health resources, their limitations, and the criteriafor accessing them. (In return, law enforce-ment agencies can provide opportunitiesfor mental health professionals to visit theirdepartments, participate in the trainingprogram, and ride along with officers.)Consumer and family member testimonialpanels can dispel misconceptions officersmay have about people with mental ill-nesses and provide officers with broaderperspectives than those based on isolatednegative encounters. Simulation exercisesallow officers to experience brief auditoryor visual hallucinations and to understandthe ways they impact daily functioning.

Challenges

• Law enforcement officers often reflect the community from which theycome. As such, they can be expected to share some of the commonly heldmisconceptions about people with mental illnesses.

• Officers may feel that staff at the mental health facilities (hospitals, crisiscenters, or other services agencies) to which they have brought peoplewith mental illnesses in the past were unresponsive or didn’t take theirshare of the responsibility for the problem. Unaware of, or unhappy with,the facility’s criteria for admission or issues of capacity, officers may befrustrated by past experiences.

• Coordinators may be nervous about experiential learning activitiesbecause, like role plays, they are unpredictable—especially when bringingtogether groups from different disciplines and backgrounds.

Chapter Four: IncreasingAwareness: SiteVisits, Testimonials, and Simulations 29

Chapter FourIncreasing Awareness:Site Visits, Testimonials,and Simulations

“This training contains a largeamount of subject matter andparticipants can get overloadedwith the information. The bestway to reinforce the material isto do it or see it. People learndifferently, and if you are goingto reach everybody in thatroom, you need to go on sitevisits.”



30

• Coordinators may also be concerned that the self-guided lessons that com-pose experiential learning activities relate to earlier content and the overallobjectives for the training, especially when the learning strategies encour-age individuals to learn through their own observations and perceptions.


� Provide opportunities to learn about livingwithmental illness.

One of the primary goals of the training program is to dispel mythsabout people with mental illnesses and thereby foster more informedresponses among officers. It is important to build empathy for consumerswho are at risk of encounters with law enforcement personnel and to under-stand their challenges, as well as the stigmas associated with their illnesses.Site visits, consumer and family member testimonials, and simulations canhelp achieve these objectives.

SiteVisits

Coordinators can schedule visits to cri-sis stabilization units, emergency rooms,inpatient facilities, and drop-in centers toencourage officers to engage with and learnfrom people with mental illnesses in a con-trolled environment. These visits presentan opportunity for officers to make astronger connection with mental healthprofessionals and other service providers.Coordinators and trainers can also helpofficers visit facilities with individualswhose mental illnesses are in more acutephases, or select facilities—such as socialclubs or drop-in centers—primarily used bypeople with mental illnesses living moreindependently in the community.

Testimonials

Most training coordinators feel that consumer and family memberinvolvement is an essential part of the initiative and lends faces to the statis-tics and incident reports. Because law enforcement personnel often see peo-ple with mental illnesses when they are incrisis, it is important for officers to hearfrom consumers who are doing well orworking to rebuild their lives. When officersmeet consumers in these circumstances,they come to appreciate that mental illnesscan affect anyone. Hearing success stories,


“The consumer does more tochange attitudes than anythingwe do.”

—officer frank webbCIT Coordinator, Houston (Tex.)Police Department

“We meet with consumers at thelocal clubhouse. The intent ofthese meetings is not just tohear stories; the intent is to seethe human side of mental ill-ness and the human side ofpolicing. This exchange is agreat learning experiencebecause we usually see peoplewhen they are at their worst.When we meet at the club-house, we see a diversity of peo-ple who have [an] illness andthe diversity of their lives.”



particularly from people who have had encounters with law enforcement, alsohelps officers understand just how much their responses can affect the livesof people with mental illnesses—both positively and negatively.

Simulations

Exercises in which officers experiencesome of the sensations or symptoms of par-ticular mental illnesses can be very effectivein building empathy for people with mentalillnesses and in increasing officers’ under-standing of their unique difficulties. Acommon tool for this exercise is the Hear-ing Voices That Are Distressing program, inwhich participants listen to audiotapes ofunsettling voices while conducting cognitive tasks and daily activities (suchas making a purchase in a store, conducting an employment interview, com-pleting puzzles) at different training stations coordinated by staff who areinstructed to act indifferent to participants’ problems.18 Providing realisticchallenges during the exercise helps officers develop empathy toward peoplewith mental illnesses. A similar tool used by some communities is the Vir-tual Hallucinations program, in which a virtual reality apparatus allows stu-dents to experience both auditory and visual hallucinations.19

Of the agencies and professionals interviewed for this guide, severalreported that these for-purchase products—which also include suggested cur-ricula—were effective at generating feelings that people with mental illnessesexperience by raising officers’ stress levels and reducing their control. Theyalso noted, however, that this experience canbe intense and some participants may evenhave emotional or physical reactions to theexercise.20 To be effective, the activities offi-cers perform while participating in the exer-cise must be relevant to the experiences aperson who hears voices would have, andthese experiences can be emotionally diffi-cult. Coordinators may want to inform theirdecision about the use of this technique bytalking to other agencies that have success-fully employed these products or asking totest them before general use.


“Our officers will tell us howimportantHearingVoicesThatAre Distressingwas;many say it was a life-changingevent.”


“When we do a site visit to thepsychiatric emergency services,officers learn about what thenurses and doctors do and howthey can help. The psychiatricstaff then ask officers how theycan help the police.”


18. At this writing, this program is available at a cost of $500 through the National Empowerment Center.Information about the Center is available at www.power2u.org.

19. The Virtual Hallucinations program was created by Janssen Pharmaceutica. For more information on theprogram, see “The Sights and Sounds of Schizophrenia,” National Public Radio (NPR) web site, postedAugust 29, 2002, and available at www.npr.org/programs/atc/features/2002/aug/schizophrenia.

20. To learn more about one agency’s experience using the Virtual Hallucinations program, see Tom Alex,“Virtual Reality Machine Gives Police Hallucinations,” Des Moines Register,March 22, 2006, available onlineat www.desmoines register.com/apps/pbcs.dll/article?AID=/20060322/NEWS01/603220343/1002, accessedMarch 28, 2007.


32

� Provide networking opportunities.

Specialized training should help officers to access mental healthresources, as well as to develop important relationships that can supportimproved responses to people with mental illnesses in the future. Site visitsand testimonials can play a significant rolein advancing these objectives.

SiteVisits

Site visits can provide officers with theopportunity to meet informally with adiverse group of mental health profession-als (such as psychiatrists, crisis workers,and intake staff) as well as consumers. Pos-itive, cooperative relationships between firstresponse officers and mental health profes-sionals are essential to the program’s suc-cess. Planned visits provide a chance for


Prioritizing Site VisitsSome coordinators choose not to include site visits to inpatient facilitiesin the training program; they may feel that officers have sufficient oppor-tunities to interact with people with mental illnesses through panel dis-cussions, and that travel issues, i.e., time, distance, and costs, makethese visits too difficult to arrange. Others feel that on-site experiencesprovide an important forum for officers to observe both mental healthprofessionals and consumers in an environment that is critical to the suc-cess of the specialized response. There is agreement that, to the extentpossible, site visits should be included in the curriculum because theyprovide a unique cluster of learning possibilities—seeing firsthand howthe facility functions andmeeting with clinicians and consumers.


“Law enforcement responders [should]transport and transfer custody of theperson with a mental illness in a safeand sensitive manner that supportsthe individual’s efficient access tomental health services and theofficers’ timely return to duty.”

Application to specialized training

Site visits can play a part in overcom-ing barriers law enforcement person-nel face in connecting an individualwith mental illness to treatment (suchas the time it takes to transfer custodyto a mental health professional) byfostering cooperative relationshipsbetween visiting officers and themental health professionals on site.

“Officers need to understandhow to engage people at thesefacilities more efficiently.Whenofficers go to the facility as partof training, there is no crisis ofthe moment and they can learnabout the procedures that typi-cally go on behind closeddoors.”

— dr. risdon slateProfessor of Criminology, FloridaSouthern College, and consumerof mental health services

Essential Element: Transportation and Custodial Transfer


mental health and law enforcement professionals to talk when they are notin the midst of resolving a call for service involving someone in crisis. Thesevisits can be structured to encourage officers and mental health practitionersto exchange information about one another’s roles, limitations, and pres-sures. Site visits also give officers a clearer picture of how a mental healthfacility operates and, just as important, what criteria the facility uses foradmitting people with mental illnesses. For example, an officer may havebeen frustrated in the past because he or she was turned away when trying tobring in an individual with a mental illness who was under the influence of anarcotic; during a trip to a facility, the officer has a chance to talk with clini-cians who can explain the facility’s policy and the reasons behind it. Simi-larly, officers can inform professionals from the mental health field on thelimits of law enforcement authority and the circumstances under which theyaddress these calls for service.

Testimonials

Panels also provide officers with firsthand information from consumersand family members about how to improve responses. The former can rec-ommend practical strategies for how officers can manage crises based ontheir personal experiences, and the latter can recommend how to obtainimportant information from loved ones and people at the scene.

� Coordinate these activities closely to ensure they runsmoothly.

Like role plays, these activities are less structured than lecture-style train-ing activities. Because of the sensitive nature of the issues being discussed, itis critical that coordinators plan them thoroughly and thoughtfully.

SiteVisits

Officers and individuals with mentalillnesses may at first be uncomfortableencountering one another in a clinical set-ting; some consumers, in fact, may evenrecognize specific officers from priorencounters on the streets. Law enforcementcoordinators should encourage participat-ing officers to ask questions to help themrespond more successfully to people withmental illnesses. Mental health practition-ers should also encourage their clients tobe candid and emphasize that there will beno negative consequences for their speaking out.

Testimonials

Advocates for people with mental illnesses who serve on the trainingcoordination group are in a good position to organize consumer and family


“We meet with consumers insmall groups at the short-termstate hospital, and we use afacilitator to guide the discus-sion. The facilitator’s job is toget the nervous consumers totalk with the nervous policeofficers.”



34

member discussion panels (and to identify compelling speakers). ManyNAMI affiliates are trained to provide In Our Own Voice, NAMI’s nationaltraining module on living with mental illness.21 The program typicallyincludes two presenters who speak for several minutes on each of fivesequential topics, from “In Dark Days” to “Coping.” Presenters offer positivestories and helpful strategies and then answer questions after each segment.Supplemental materials include a training manual, a program description,and core objectives. These presenters may also be able to offer specific sug-gestions to help officers better interact with consumers and family membersand handle crisis situations more effectively.

Simulations

Because of the intense nature of the simulation exercise, agencies thatdecide to use this technique should schedule it for the end of the day to pro-vide officers with time to process the experience. Coordinators may also wantto continue the discussion about this exercise during a morning session orroll call the following day to address any residual or emerging questions orconcerns officers may have.

� Debrief with officers after experiential learning activities.

Experiential learning will be more effective if officers have an opportu-nity to reflect on their experiences and learn from their peers’ experiences.This is particularly important with simulation exercises.

Simulations

For as long as an hour after the activities have been completed, facilita-tors should direct questions at participants to help them identify the methodsused to cope with the voices they heard while trying to complete cognitivetasks. Some communities initiate the debriefing with questions meant toprompt officers to think about the sense ofdisorientation and confusionthey experienced during the activity.

In adapting simulation materials for alaw enforcement audience, training expertsnote that debriefing questions should focuson perceptions and experiences rather thanon feelings. For example, questions like“Did you go on an elevator with other peo-ple?” and “Did you have a harder time con-centrating in one activity than another?” aremore likely to generate dialogue than ques-tions such as “How did it feel to live with


“We ask the officers how theydealt with the voices. Some tellus they tried to tune [thevoices] out, some say that theywhistled . . . This is anotherway to demonstrate differentcoping techniques.”


21. For more information on NAMI’s In Our Own Voice program, see www.nami.org/template.cfm?section=In_Our_Own_Voice. To find the nearest NAMI affiliate, see www.nami.org/Template.cfm?section=your_local_NAMI.


mental illness during this exercise?” Debriefing also provides an opportunityfor people who operated the different activity stations to talk about how partic-ipants performed during the exercise. In addition to helping participantsreflect on the experience of the program, the debriefing should provide anopportunity for officers to articulate how this experience might change theirapproach to someone who is having hallucinations. Facilitators should look totie this discussion to training on recognizing behaviors, developing communi-cation strategies, and de-escalating situations.



No single document can capture the full range of innovative strategies juris-dictions have explored to overcome challenges in training to improve lawenforcement responses to people with mental illnesses. This publicationattempts to highlight some common and promising approaches while recog-nizing that adaptations will be necessary. By focusing on the challenges andstrategies specific to training law enforcement officers to respond effectivelyto people with mental illnesses, this guide necessarily excludes more generallessons learned from other types of training for law enforcement profession-als. As such, coordinators and trainers should consider this guide a startingpoint and should consult with colleagues—both those with general trainingexperience within their agency and those who have conducted training onlaw enforcement responses to people with mental illnesses in other agen-cies—to explore strategies more fully.

As a guide to training on effective law enforcement responses to peoplewith mental illnesses, much of this discussion focuses on collaboration withmental health professionals, consumers, and other stakeholders—whether bycross-training, pairing trainers from different disciplines, or using appropri-ate language. But like other community policing initiatives, this effort cannotsucceed without the commitment of top law enforcement leadership andchampions throughout the department. A message from the chief executiveon the value of the program and the partners to the agency can energize par-ticipants, trainers, and coordinators, and enrich partnerships at the core ofan effective response. Strong leadership and commitment across all ranksand in all support positions within an agency are essential to improving howlaw enforcement will interact with people with mental illnesses—and it allbegins with unwavering support for effective training.

Conclusion 37

Conclusion


AppendixA:Advisory Board Members 39

This document is part of a series of resources for law enforcement practition-ers and their community partners that the Bureau of Justice Assistance(BJA), U.S. Department of Justice, is developing as part of the Law Enforce-ment/Mental Health Partnership Program. The Improving Responses to Peoplewith Mental Illnesses series comprises a collection of resources, built to com-plement The Essential Elements of a Specialized Law Enforcement–Based Pro-gram, which includes descriptions of methods used to tailor the jurisdiction’slaw enforcement response to the unique needs of the community and anonline database—the Criminal Justice/Mental Health Information Net-work—that includes information on local law enforcement responses to peo-ple with mental illnesses. Staff are also completing a concise research guidethat will detail related research findings and their implications for the field.This project is coordinated by the Council of State Governments Justice Cen-ter with guidance from the Police Executive Research Forum. An advisoryboard, listed alphabetically below, has guided the scope and direction of thisseries as a whole.22

• Mr. Stephen Baron, Director, District of Columbia Department of MentalHealth

• Ms. Lesley Buchan, Program Director, Community Services Division,National Association of Counties

• Major Sam Cochran, Crisis Intervention Team Coordinator, Memphis(Tenn.) Police Department

• Dr. Steven M. Edwards, Senior Policy Advisor for Law Enforcement,Bureau of Justice Assistance, U.S. Department of Justice

• Mr. Leon Evans, Executive Director, Bexar County (Tex.) Jail DiversionProgram

• Deputy Chief Del Fisher, Arlington (Tex.) Police Department

• Ms. Elaine Goodman, Former Coordinator, NAMI New Jersey LawEnforcement Education Program

• Mr. Ron Honberg, Director of Legal Affairs, NAMI

AppendixA:Advisory BoardMembers

22. The titles and agency affiliations included here reflect the positions the advisory board members heldat the time of their involvement with the project.


40

• Ms. Linda Keys, Director of Clinical Services, Mental Health Center ofDane County (Wis.), Inc.

• Mr. Adam Kirkman, Project Associate, GAINS TAPA Center for JailDiversion

• Commander Barbara Lewis, Orange County (Fla.) Sheriff’s Office

• Chief Stefan LoBuglio, Montgomery County (Md.) Pre-Release and Re-EntryServices Division

• Officer Joan M. Logan, Crisis Intervention Team Coordinator, MontgomeryCounty (Md.) Police Department

• Mr. Loel Meckel, Assistant Director, Division of Forensic Services,Connecticut Department of Mental Health and Addiction Services

• Ms. LaVerne Miller, Director, Howie the Harp Peer Advocacy Center

• Chief Richard Myers, Appleton (Wis.) Police Department

• Ms. Ruby Qazilbash, Senior Policy Advisor for Substance Abuse andMental Health, Bureau of Justice Assistance, U.S. Department of Justice

• Ms. Rebecca Rose, Policy Advisor, Bureau of Justice Assistance, U.S.Department of Justice

• Ms. Michele Saunders, Executive Director, Florida Partners in Crisis

• Sergeant Rick Schnell, San Diego (Calif.) Police Department

• Ms. Bonnie Sultan, CIT Technical Assistance Center Coordinator, NAMI

• Dr. Bruce Taylor, Director of Research, Police Executive Research Forum

• Representative John Tholl, Vice-Chair, Criminal Justice and Public SafetyCommittee, New Hampshire House of Representatives

• Lieutenant Richard Wall, Los Angeles (Calif.) Police Department

• Lieutenant Michael Woody (ret.), Law Enforcement Liaison, Ohio CriminalJustice Coordinating Center of Excellence

AppendixA:Advisory Board Members


Strategies for Effective Training is meant to supplement and enhance a trainingcurriculum for improving law enforcement responses to people with mentalillnesses. This list of suggested training topics provides an overview and ori-entation for coordinators who are in the early stages of curriculum develop-ment. In communities with active training initiatives and curricula, this listcan serve as a curriculum redesign checklist.

This list is a starting point only and represents the more commonlyused categories. It is not meant as a comprehensive inventory of potentialtopics. Through their multidisciplinary training planning committee, coordi-nators can use this list to prioritize and identify areas to further research.Coordinators may decide to add to or subtract from this list, depending ontheir community’s needs and interests.

Authors of this guide compiled this list based on a comprehensive reviewof existing curricula and input from experts. A first draft of suggested trainingtopics was developed by a panel of law enforcement experts convened by theLaw Enforcement Advisory Board to the Criminal Justice/Mental Health Con-sensus Project (for more information, including the names of these advisors,see http://consensusproject.org/the_report/toc/law-enforcement-advisory-board). Topics were further discussed with some of the advisors to this docu-ment (listed in the acknowledgments at the front of this guide).

To learn more about any of these topics, readers can refer to the curric-ula resource list in appendix C. Readers are also encouraged to reach out totheir local partners for clarifications on topics in their area of expertise.

A. Understanding Mental Illnesses

1. People with mental illnessesa. Major challengesb. Barriers to effective mental health treatments and supports

2. Understanding what is considered a mental illnessa. Specific mental illnessesb. Common medications and side effectsc. Co-occurring disorders

3. Understanding what are not mental illnessesa. Differences between mental illnesses and developmental disabilitiesb. Differences between mental illnesses and neurological disorders

(e.g., epilepsy, Alzheimer’s disease, Tourette’s syndrome, and autism)

Appendix B: SuggestedTrainingTopics 41

Appendix B:Suggested Training Topics


42

4. Attitudes about mental illnesses (e.g., misconceptions, discrimination,and stigma)

5. Mental illnesses and cultural and gender differences

B. StatutoryAuthorities Governing Law EnforcementResponses

1. Federal lawsa. Rehabilitation Act (1973)b. Civil Rights Act (1983)c. Americans with Disabilities Act (1990)

2. State and local statutesa. Review of specific state statutes/local ordinancesb. Civil liability of law enforcement officers

3. Limits of information sharinga. Confidentiality of medical information

4. Law enforcement report writing

C. Law Enforcement Response to Calls for Service

1. On-scene assessmenta. Signs and symptoms of mental illnesses: verbal and behavioral cuesb. Medical or situational causes of crisis behaviorc. De-escalation techniques/communication skillsd. Suicide prevention and managing other high-risk situationse. Victim/witness assistance

2. Response optionsa. Noncustodial law enforcement options

i. Counseling, release, and referralii. Linking people to appropriate treatments and supportsiii. Local hospital-based psychiatric and substance abuse servicesiv. Mobile crisis teams

b. Custodial law enforcement optionsi. Involuntary emergency evaluation and civil criteriaii. Arresting a suspect with a mental illnessiii. Custodial transport

3. Law enforcement lockupa. Interviewingb. Suicide screeningc. Medications management

Appendix B: SuggestedTrainingTopics


Appendix B: SuggestedTrainingTopics 43

D. Community Policing/Problem Solving

1. Partnershipsa. Mental health care providersb. NAMI and other mental health advocacy organizationsc. Other criminal justice officialsd. Substance abuse treatment providerse. Housing providers

2. Problem solvinga. Using the SARA model (Scanning, Analysis, Response and Assessment)

E. Use of Force

1. Hostage/barricaded suspect

2. Officer safety

3. Suicide-by-cop


44

As jurisdictions across the country implement specialized law enforcement–based responses to people with mental illnesses, information and resourcesavailable to assist other communities initiating training processes greatlyincrease. This section describes several high-quality training curricula (start-ing with most recent releases) that authors of this report reviewed in thecourse of identifying effective training strategies. Readers may find theseresources useful as they are compiling their own curricula. Authors do notconsider this list an exhaustive inventory, but rather illustrative of differentapproaches. Readers can use this list as a starting point, or for comparisonpurposes, in designing their own training materials.

author: Larry Thompson, Editortitle: A Toolkit and Resource Guide for Behavioral Healthcare Communities,2nd ed.date: 2007publication information: University of South Florida, Louis de la ParteFlorida Mental Health Institute, Department of Mental Health Law andPolicyavailability: Contact Dr. Larry Thompson, [email protected]: No fee

The Louis de la Parte Florida Mental Health Institute supports law enforce-ment agencies and their communities by providing tools and information forofficer training on responding to encounters with people with mental ill-nesses. Modules in this resource guide are intended to assist communities indeveloping training for crisis intervention teams. Modules provide instruc-tion on crisis intervention techniques, the Baker Act, recognizing signs andsymptoms of mental illnesses, and evaluating suicide risk; sections also offerconsiderations for role plays and other teaching methods.

author: Montgomery County (Md.) Police Departmenttitle: Crisis Intervention Team Trainingdate: 2006publication information: Montgomery County Police Departmentavailability: Contact Officer Joan M. Logan, 2350 Research Boulevard,Rockville, MD 20850, [email protected], 240-773-5057cost: No fee

Appendix C: Curriculum Resource List

Appendix C:Curriculum Resource List


The Montgomery County (Md.) Police Department created a CIT program in2000, which is coordinated by Officer Joan Logan at this writing, the primaryauthor of this curriculum. Several hundred police officers and other publicsafety personnel have received training based on this curriculum. The train-ing consists of 40 hours of both classroom and practical exercises focusingon identifying, assessing, interviewing, and safely addressing people withmental illnesses, brain injuries, or developmental disabilities.

author: New York State Division of Criminal Justice Services, Office ofPublic Safety; and Office of Mental Health, Division of Forensic Servicestitle: The Police–Mental Health Recruit Trainer’s Manualdate: 2006publication information: New York State Office of Mental Health,Division of Forensic Servicesavailability: http://www.omh.state.ny.us/omhweb/forensic/police.htmcost: Small fee

New York’s Office of Public Safety and Division of Forensic Services designedthe Police–Mental Health Coordination Project as a two-day mental healthtraining curriculum for recruit-level police officers. The training program isdesigned to enable officers to identify signs and symptoms of “emotional dis-turbances,” understand their causes, better appreciate the experience of liv-ing with a mental illness, utilize the state’s Mental Hygiene Law to makeeffective assessments and interventions, and appropriately document theiractions. Role play is a critical component of this training. The agencies alsoprepared a one-day in-service curriculum entitled “Responding to SituationsInvolving Emotionally Disturbed People,” which contains more advancedcontent regarding types of mental illnesses, suicide assessment and interven-tion strategies, and methods for responding to people with acute symptomsof a mental illness.

author: Florida Regional Community Policing Institutetitle: Managing Encounters with the Mentally Illdate: 2005publication information: Florida Regional Community Policing Institute,St. Petersburg Junior College, St. Petersburg, Floridaavailability: http://cop.spcollege.edu/cop/training/mental.htmcost: Free download

This 16-hour, two-day curriculum focuses on practical solutions and interven-tions for community police officers to assess and manage encounters withindividuals with mental illnesses. It includes interactive activities designedto promote proactive management of situations in which individuals requireassistance, crisis de-escalation, or transportation to a mental health facility.Course content is presented without psychological, medical, or diagnostic ter-minology, and is intended to provide straightforward information that reducesmisunderstanding and stigmatization of people with mental illnesses.

Appendix C: Curriculum Resource List 45


46

author: Police Executive Research Forumtitle: Police Response to People with Mental Illnessesdate: 1997publication information: Washington, D.C.: U.S. Department of Justice,Disability Rights Sectionavailability: http://www.policeforum.org/perf/store.aspcost: Small fee

Police Response to People with Mental Illnesses is a training curriculum andmodel policy with modules on the Americans with Disabilities Act, types ofmental illnesses, treatment options, voluntary and involuntary commitment,psychiatric evaluations, and other issues or situations that police may en-counter. These modules can be used either separately or together. The cur-riculum offers techniques and model practices for police officers to deal witha variety of situations, from talking to a person who is experiencing delu-sions to transporting a person to a mental health facility for evaluation.

Appendix C: Curriculum Resource List


The Bureau of Justice Assistance, Office of Justice Pro-grams, U.S. Department of Justice, provides leadership train-ing, technical assistance, and information to local, state, andtribal criminal justice agencies to makeAmerica’s communi-ties safer. Readmore at www.ojp.usdoj.gov/BJA/.

The Council of State Governments (CSG) Justice Center is anational nonprofit organization serving policymakers at thelocal, state, and federal levels from all branches of govern-ment. The CSG Justice Center provides practical, nonpartisanadvice and consensus-driven strategies, informed by avail-able evidence, to increase public safety and strengthencommunities. Readmore at www.justicecenter.csg.org.

The Criminal Justice/Mental Health Consensus Project is anunprecedented national effort coordinated by the CSG JusticeCenter to improve responses to people with mental illnesseswho become involved in, or are at risk of involvement in,the criminal justice system. Readmore at www.consensusproject.org.

The Police Executive Research Forum (PERF) is a nationalmembership organization of progressive police executivesfrom the largest city, county, and state law enforcementagencies. PERF is dedicated to improving policing andadvancing professionalism through research and involve-ment in public policy debate. Readmore at www.policeforum.org.


Notes


Council of State GovernmentsJustice Center

www.justicecenter.csg.org

100Wall Street

20th Floor

New York, NY 10005

tel: 212-482-2320

fax: 212-482-2344

4630MontgomeryAvenue

Suite 650

Bethesda,MD 20814

tel: 301-760-2401

fax: 240-497-0568

504W. 12th Street

Austin,TX 78701

tel: 512-482-8298

fax: 512-474-5011

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