Title: Memphis, Tennessee, Police Department's Crisis Intervention Team.
Series: Bulletin (Practitioner Perspectives)
Author: Betsy Vickers
Published: July 2000
Subject: Crisis Intervention, Police Training
19 pages
45,056 bytes

----------------------------

Figures, charts, forms, and tables are not included in this ASCII plain-text file.
To view this document in its entirety, download the Adobe Acrobat graphic file
available from this Web site or order a print copy from BJA at 800-688-4252.

----------------------------

"I try to visit as much as I can, but Charlie Shift is really busy. There's a little
boy, Bobby, 12 years old. Sometimes he gets real angry at things and gets in
fights with his little brother. I try to stop in every now and again and make sure
things are good, if he's keeping with his medication and trying to work things
out. It also shows somebody cares and wants to help him. The parents are real
cooperative. They like to see you coming. If there was ever a problem, I'm sure
Bobby's mother would call and ask for me." 

CIT Officer Carl Craig

----------------------------

Memphis, Tennessee, Police Department's Crisis Intervention Team

By Betsy Vickers

January 2000, Memphis, TN--Delta Watch: 1700 to 0100: 911 Calls

2100 Call

Three police officers, four firefighters, and two paramedics fill the modest living
room that has been decorated with evident pride. Green overstuffed furniture
and drapes in lavish folds and swags are accented by clusters of unlit red
candles shaped like rose blossoms. Everyone's attention is focused on Eugene,
an agitated 17-year-old who sits on the couch. His grandmother, whose
perfectly kept house this is, moves about, volubly retelling her story.

2315 Call

In an upper middle-class neighborhood, the front door of the house on a small
rise from street level stands wide open, a glowing rectangle of yellow light. On
entering, an expanse of polished hardwood and austerely furnished rooms
creates an ambiguous impression of a household in the process of becoming or
undoing. The ominous stillness is broken by the bounding of a young black
Labrador retriever, chased from the back of the house by a man in his
midtwenties. Behind them, in the kitchen, a blond, 28-year-old woman, Helena,
leans languidly against the counter, flanked by two paramedics and faced by a
police officer.

The CIT Program

On a day's or night's routine patrol duties, Memphis police officers may
respond to a number of dispatch calls before receiving one specifically for a
member of the Crisis Intervention Team (CIT). CIT officers are regular patrol
officers who have gone through an intensive 40-hour training program to learn
how to respond to the mentally ill in crisis. The effective CIT officer is able to
respond to and understand the needs of a consumer, as mentally ill people are
called, and demonstrates sensitivity and caring.

The city of Memphis has seven precincts and nine wards. All 911 calls come
into the police department's command center, from which officers are
dispatched by precinct and ward. Paramedics and firefighters respond to 911
calls when there is a medical emergency. CIT officers respond to situations
having a mental health component.

Because patrol officers are assigned to a specific ward, they know their sector
intimately. They are familiar with both its law-abiding citizens and its
lawbreakers. They can identify the substance abusers and the chronically
mentally ill. Calming consumers in emotionally explosive situations that could
erupt into violence is their job. Sometimes a calming influence is all that is
needed; other times a consumer must be hospitalized. The CIT program works
because of the police partnership with the University of Tennessee Medical
Center, referred to as The Med. At the discretion of CIT officers, consumers
may be brought to The Med 24 hours a day, 7 days a week. With access to an
organized reception facility, emergency medical and psychiatric units, and
criminal medical/psychiatric treatment areas, CIT officers can leave consumers
in capable hands and be back on patrol within 15 minutes.

The Memphis CIT program is gaining recognition throughout the United States.
Several cities--Albuquerque, New Mexico; Portland, Oregon; San Jose,
California; Seattle, Washington; and Waterloo, Iowa--have already put in place
response programs based on the Memphis model, and requests arrive daily
from all over the United States for CIT training information.

The goals of the CIT are to provide immediate response to and management of
situations where the mentally ill are in a state of crisis; prevent, reduce, or
eliminate injury to both the consumer and the responding police officer; find
appropriate care for the consumer; and establish a treatment program that
reduces recidivism.

2100 Call

Eugene's grandmother explains that he has just spent 13 days in the Memphis
Mental Health Institute (MMHI). CIT officers are trained to change a
confrontation into a less hostile meeting. As a starting point, Officer Mike
Schafer asks Eugene what medication he is taking. He is told Haldol (to treat
schizophrenia and other types of psychoses) and Cogentin (to counter the
effects of other drugs and help him sleep) for a 30-day trial period. Eugene is to
take his medications right before bedtime. This evening he took them early and
then wanted to go out with his friends. His grandmother said he couldn't
because he had taken his pills, and an argument ensued.

"He was shouting and perspiring so much he soaked right through his clothes,"
she said. She had made the 911 call because, in the middle of the altercation,
Eugene had suffered chest pains. The paramedics have found nothing physically
wrong with him.

CIT Officer Schafer asks Eugene for his version of the events. At times, Eugene
seems to lose connection, his eyes rolling. His grandmother repeatedly
comments on his version until a police officer guides her away. As the crux of
the dispute is reached, Eugene jumps up gesticulating and is told firmly to sit
back down. He complies and complains about the way the doctor at MMHI
looked at him and was reticent about sharing information about his medications.
Eugene is desperate for information about his illness.

"I want help," he cries, "but I don't like the medication. I don't feel good. I have
chest pains. I need to play basketball so I can get a scholarship to Shelby State.
What I want to know is, am I going to be able to run full court if I take the
medication?"

Officer Schafer explains that he must take the medication before bedtime,
because it will help him sleep. After 30 days his prescription would be
reevaluated. As he speaks, he checks with Eugene to make sure he is listening
and understands. He also advises Eugene to listen to his grandmother. He lives
in her house, and she has his best interests at heart. Back in the patrol car, he
shakes his head at the poignancy of Eugene's concerns.

2315 Call

Sleepy, depressed, Helena responds slowly and with tonal flatness to Officer
Schafer's questions as he establishes the chain of the evening's events. She had
been out drinking at a neighborhood bar with her husband. Arriving home, she
took a large quantity of her husband's antibiotics, Cephalexin, washed down
with vodka. The nearly empty bottle stands on the counter. Initially, her
husband had no idea his wife was in distress, and he is still off balance. It is he
who called 911. One of the other officers takes him to another room to ask
about his version of events and allow Helena the privacy to speak her mind.

Officer Schafer asks Helena why she took the pills. She replies, "I'm tired of
life. Life is so heavy."

"Did something happen between you and your husband?"

Helena shakes her head as Officer Schafer explains that she will have to be
taken to The Med. She does not want to go and says she feels fine. He says
evenly that it is no longer her choice, "Once the paramedics are called, you
must go and be examined."

When The Med is the destination, a CIT officer will either take the consumer in
the patrol car or meet the ambulance there. Put on the stretcher for the ride,
Helena is rolled into the emergency room (ER). She is now shaking. Officer
Schafer signs her in as a medical team takes over. Within 20 minutes he is
sitting in the patrol car completing the paperwork.

Why the CIT Was Born

The deinstitutionalization of the mentally ill in the 1960s, requiring the release of
nonviolent patients was laudable in theory. Release back into the community,
the resultant downsizing of mental health institutions, and the development of
drug therapies were heralded by rights advocates. The money saved by hospital
closings was to be put into outpatient community programs. 

Unfortunately, the money did not end up in the community. Instead, states
rebudgeted the savings, and many mentally ill people found themselves without
appropriate social services and support systems. Without monitoring, many
stopped taking their medication, while others continued with medications that
had severe side effects and quickly became outmoded. This resulted in many
unstable individuals living in the community with their families who were
unprepared for the role of caretaker, or in the too few halfway houses and
group homes, or on the street. 

When people with mental illness became psychotic, quality-of-life initiatives in
the community led to some rough handling. The police were most commonly
called and, as Mary Zdanowicz of the Treatment Advocacy Center (TAC)
observed, "Officers were serving as frontline mental health workers."

As is often the case, it took a crisis, a shocking incident, and the ensuing public
outcry to crystallize existing efforts into solutions in Memphis. The city, with a
population of 630,000, demonstrates enormous civic pride. Evidence is
everywhere of a small town still trying to recover from the devastating effects of
the flight of middle-class whites by trading on its tradition of Delta blues, the
music and watering holes of Beale Street, the reputation of its regional cuisine,
and the ongoing attraction of its favorite son, Elvis Presley. 

As part of its contemporary face, Memphis is involved in business attraction
efforts. A number of downtown office and bank buildings, including a new
police headquarters and courthouse, have been built and others are being
renovated. Parts of downtown have a barren quality, suffering from the
wrecking ball of urban renewal before new construction comes in to fill the
gaps. 

Another Memphis fans out from the downtown restoration. Half of the city's
population is African American, the majority living at the poverty level. There is
little neighborhood integration, and black and white residential areas are insular
and separated.

In September 1987, against this polarized backdrop, some white Memphis
police officers answered a 911 call. A young African-American man with a
history of mental illness was cutting himself with a knife and threatening suicide.
Police officers are trained to respond with deadly force when they perceive
their lives are in danger. At the outset of the incident, it appeared that the only
life in danger was the young man's from self-inflicted wounds. As they were
trained to do at the time, officers at the scene confronted the man and
demanded he drop his weapon. At this, he became more upset and ran at the
officers who, in fear for their own safety, opened fire and killed him.

Although the welfare of both officers and the mentally ill in situations of
confrontation had been a concern for some time, this death, with its racial
overtones, was the catalyst that resulted in the creation of CIT a year later.


CIT's Formation

The public outcry in the aftermath of the shooting caused the mayor to establish
a task force. He enlisted the input of the police, the heads of the psychology
department and the medical center at the University of Tennessee, the head of
the psychology department of the board of education, representatives from the
University of Memphis and the National Alliance for the Mentally Ill (NAMI),
the managers of mental health facilities in Memphis, and local citizens. This
group was charged with finding ways to prevent such tragedies in the future.

"The mayor was really smart by making it a community thing and keeping it
simple," said CIT Coordinator Lt. Sam Cochran. "He said he wanted the task
force to come back with a program that would provide safety for the officers,
for the mental health consumers, and for their family members. That was
generic, mutual ground. Who could be against that? When you are talking about
system changes--government and private institution changes--you are going to
need some political clout. The mayor gave that to the task force. As this thing
grew, partnerships grew. At some point money was going to come into it, but it
was clearly put down that this was not to be about money, but about the
community."

At the time of the shooting, Police Director Walter Crews was in charge of
hostage negotiation and was asked to join the task force. He recalled, "Back
then if a mentally ill person was violent when the police arrived, it usually ended
up with the consumer and the police being injured. What we tried to do was
look at a plan that would allow us to insert a tool that would help us, as a police
agency, bring the consumer under control, which was a diversion from our
normal tactic. I knew immediately that education and technology would be the
keystone."

A Partnership Program

Without a committed partnership among the constituents affected by the needs
of the mentally ill, no program will get off the ground, much less succeed. In
Memphis, those constituents are the families of the mentally ill, law enforcement
agencies, emergency medical/psychiatric services, regional short- and
long-term receiving hospitals, and the consumers themselves.

Families of People With Mental Illness

The concept of CIT was formed in 1983 when NAMI Memphis, a local
division of the National Alliance for the Mentally Ill, held its first meeting. The
initially small group consisted of parents of mentally ill children who found they
could not get the help they needed for their children and themselves from the
police, state agencies, or mental health facilities. They became activists and had
a hand in revising the Tennessee state code covering mental health. Today,
some family members regularly assist instructors teaching the 40-hour CIT
officer training program.

Law Enforcement Agencies: Memphis Police Department CIT

The Memphis Police Department employs some 900 uniform patrol officers. Of
that total, 213 are CIT patrol officers. Efforts have been made to have a
diverse staff: 112 officers are white men, 11 are white women, 62 are black
men, 27 are black women, and 1 officer is an Hispanic male.

As well as overseeing the Hostage Negotiation Team and Critical Incident
Services, Lt. Cochran coordinates the Crisis Investigation Bureau. He has held
this position for the past 10 years, and his leadership has shaped the program.
For Lt. Cochran, the CIT program is so close to a calling that his evangelical
zeal galvanizes the officers who work in the program.

Because the financial incentive to be a CIT officer is small ($45 a month extra),
Lt. Cochran does everything he can to encourage and reward his people. He is
in regular contact with the officers, both in person and through a newsletter that
offers the latest information on dealing with consumers, points them to published
recognition of CIT activities, and notifies them of upcoming inservice training.
Other rewards are a CIT identifying pin, an annual NAMI awards dinners,
written commendations for outstanding service, and a chance for a promising
officer to assist Lt. Cochran for a few months and learn the administrative side
of the program. This sort of attention sets CIT personnel apart from their fellow
officers, promotes camaraderie, and allows them to see themselves as a
specialized unit.

Emergency Medical/Psychiatric Services Staff: The Med

----------------------------

The University of Tennessee Medical Center Psychiatric Unit

Dr. Kendall Vitulli, Medical Director
Dr. Marie Tobin, Staff Psychiatrist Psychotropic Medicines
Dr. Randy Dupont, Head of Psychiatric Services

o 400-500 psychiatric ER admissions for evaluation per month.
o 350 brought in by CIT officers.
o 40-50 percent new patients.

----------------------------

Without The Med's open-door policy, the CIT program would not work. The
synergistic system is designed to admit within 15 minutes whoever is brought in
by the police. The quick transfer from officers to the mental health facility is
considered the key to the program's success. It is also noteworthy that without
the agreement of all entities in the health services on The Med's clearinghouse
role, turf wars could break out among hospitals looking for their share of
regional patients requiring care.

Guided by state statute, CIT officers make the judgment in the field whether a
consumer is dangerous to himself or others and if transport to The Med is
appropriate. At The Med, the consumer is placed in protective custody with no
charges, after which the doctors decide if the consumer should be transferred to
the state hospital or guided to another solution. These solutions involve referral
to various community resources, such as medical detoxification programs,
mental health centers, rehabilitation programs, and social service agencies.

The medical component serves the following critical functions:

o It ensures cooperation among the advocates; the medical, psychological, and
psychiatric communities; the police department; and the state hospitals.

o It protects against dumping--misrepresenting the situation to off-load the
consumer in trouble.

o It gives doctors the time to assess patients--extremely important with
co-occurring substance abuse and mental health disorders.

o It provides appropriate patient care: 

--Treating medical problems.

--Restarting medication and releasing to current living situation or finding a new
one.

--Placing in a short- or long-term care mental hospital. 

--Offering rehabilitative care.

--Arranging for continuous care services.

--Assigning a case manager.

"All parts of the system encourage the flow to come through here and not the
jail, and that's the bottom line," said Dr. Randy Dupont, head of The Med's
psychiatric services. "If this doesn't turn out to be mental illness, but turns out to
be alcohol or drugs, or dementia in the elderly, that's our problem. This is still a
health-care issue, but we are not going to try to figure that out at the door." 

Dr. Dupont observed, "Most crisis facilities' failings happen because they are
underfunded, so they tend to start to restrict the doorway. Pretty soon there are
facilities that will not take the handicapped, will not take the blind, the mentally
ill, or those under the influence of alcohol and drugs. If I were a police officer, I
would be asking, 'Well what do you take?' We are going to take all comers,
and will sort it out. If it turns out to be a complicated medical problem which
needs surgery, we can take that too. I think our ability to take care of the range
of needs is what is impressive."

The Consumers

Officer Stacey LaMondue, 1998 CIT Officer of the Year, exemplifies the
dedication and caring for consumers required of CIT work. She perceives
herself as a first responder whose job is meeting people, learning their needs,
and acting as a referral source. When her regular duties allow, she visits the
consumers in her ward. Because she works the 0700 to 1500 Bravo Watch,
she is better situated to do this than officers on nighttime shifts. One of the
reasons she visits is that regularly interacting with "her" consumers allows them
to feel comfortable calling her if they have a question, need help obtaining a
ser-vice, or sense they are about to have an episode.

"A lot of people think they can only call us when it is totally out of control," said
Officer LaMondue. "I would rather come when things aren't full blown. Many
consumers do have presence of mind. I hadn't seen Alvin in a couple of years
and last week, he calls and says the voices are coming back up on the TV,
telling him to walk here and there. They can call a police officer in their area
and this is someone with whom they've established rapport and might be readily
available. If they call the hospital they've got to leave a message, be put on
hold, or hear an unfriendly or strange voice on the phone."

A fellow CIT officer reported to her that he had seen one of her consumers
wearing a bottle cap pretending it was a CIT pin. When she heard this, she
stopped by police headquarters to pick up a CIT pin, drove out to the group
home where he lives, and ceremoniously pinned on the badge. That same visit,
she helped another consumer negotiate with the head of the home over how
much spending money he should have from his disability check and waited
while he telephoned his caseworker for information.

When asked if she ever felt fear around consumers, Officer LaMondue replied,
"If an officer tells you they are never afraid, they're lying. You need some fear
to survive. With some consumers, the delusion has taken over and you can't
break through. This person doesn't see you as you but as whoever the
aggressor is in their delusion, and may attack you. So I can be in control of the
situation where I have total compliance one second and lose it the next just
because of a delusion. You have to be aware and prepared. I can't have bad
days because I have to be responsible for myself, my coworkers on the scene,
and the consumer. And we all have to get in and out safely. If it goes wrong, it's
my fault."

Success Depends on Training

CIT Training at the Memphis Police Training Academy

Lt. Cochran insists there is no magic to the training program he helped devise
for his CIT officers. He is proud that officers readily complete the 40-hour
training program in addition to the annual week of inservice training required for
all police officers. After that, CIT officers receive another 8 hours of specialized
training.

Perhaps the most important aspect of the program is that the instructors'
involvement is on an in-kind basis. Each partner agency donates instructional
staff. Because of the instructors' volunteer status, the sense of ownership of and
investment in the success of the program is enhanced.

The training consists of fundamentals in recognizing mental illness; instructions
on psychotropic medications; small-group visits to Veterans' Administration and
state mental hospitals facilitated by NAMI members; visits to patients' homes; a
tour of Lowenstein House, where consumers learn job skills; crisis deescalation
skills; and defense weapons training. There are more than 9 hours of role
playing, with distinctive goals and objectives, in which seasoned CIT officers
participate. 

Health Professionals

It was not smooth sailing in the early days. The task force had developed a
training program, but Lt. Cochran said that when the health professionals came
in to teach, "it was like cats and dogs. We thought what they said about how to
handle the mentally ill and people who were acting out high on drugs was the
stupidest stuff we ever heard. We were saying, how are you going to handle
these big men? And they just [heard police ignorance of the consumers' reality].
The truth of the matter is we didn't know each other. We were polite, but when
it came down to it, both sides had their prejudices and preconceived ideas
about how the others did or didn't do their duties. We said, 'We gotta get these
health people into the cars so they can see, so the officers can have some
credibility.' " Mutual education took place, and understanding and a sense of
partnership grew.

Dr. Dupont starts the training week by introducing some rudimentary diagnostic
concepts and showing videotapes of consumers with diagnostic mental
illnesses--such as depression, bipolar disease, schizophrenia, and obsessive
compulsive disorder--to teach the officers how to recognize the illnesses. He
discusses acting out on delusions and how alcohol/drugs exacerbate behavior.

Dr. Maria Tobin, a staff psychiatrist, lectures on psychotropic medicines. She
said, "Most students' eyes kind of glaze over after you mention the first
medicine, but I give it a shot. We use Dr. Dupont's videos of particular
diagnoses that they have seen before. Afterwards they know what medicines
you might find lying around when they go into a consumer's house. I think the
officers quite like having this knowledge; it empowers them."

Speaking a common language with the doctors gives officers the ability to
report on the medications prescribed and to assess and describe a consumer's
condition. When they arrive at The Med, this information is invaluable to the
doctors.

"If, for instance, the officer reports the consumer has said, 'I have the devil
riding on my back,' this indicates psychosis to us," said Dr. Tobin.

Weapons

Sometimes reasoning alone cannot diffuse a crisis. A consumer in the grip of a
psychotic episode can be surprisingly powerful. Officers are trained to keep
their distance. If a deadly weapon is in the hands of the person in crisis, the
danger is magnified.

Over time, police have tried various methods to subdue consumers from a safe
distance. The taser gun shoots two darts that provide high-voltage but
low-amperage shock on contact and cause the person to fall to the ground. At
times, someone in the grip of psychosis will have an unusual resistance to shock
and a high tolerance for pain. In addition, an individual living on the street may
be wearing many layers of clothing, which the darts cannot penetrate. 

Pepper spray also has proved to have limited effectiveness in the same
circumstances and must be sprayed at a close range. Pepper foam is more
concentrated, but again must be discharged at a possibly unsafe distance,
particularly if the consumer has a weapon. Given the goals of using the minimum
amount of force necessary for officers to accomplish their duties and ensuring
that neither the officer nor consumer be injured while the situation is brought
under control, a better method had to be found.

The solution was the Impact Delivery System (IDS), specifically the Sage
Less-Lethal Launcher (SL-6). The IDS is designed for a contained situation,
one in which negotiation has failed and the consumer, in danger of harming
oneself or others, must be immobilized in a nonlethal way. Police have rarely
had to fire it. The visual intimidation factor when the IDS is produced is often
enough to convince someone to be reasonable.

IDS is an imposing 10.6-pound rifle with a large ammunition canister, giving it
the appearance of a modern-day tommy gun. The IDS' cartridge is a 37mm
rubber baton that travels at 140 miles per hour when launched and has both
near- and far-firing impact capabilities. Each launcher costs $1,500. The need
for IDS is what involved the Bureau of Justice Assistance (BJA) in the CIT
program. The Memphis Police Department applied to BJA under the Local
Law Enforcement Block Grants Program. The department received money for
12 IDS launchers and cases, a number of rubber projectiles, and baton
reloaders. The police department has since purchased more launchers,
providing two IDS per precinct. 

Police officers who show up at a volatile scene follow a use-of-force
continuum. CIT officers must not only know the stages of the continuum, but
also learn and use communication techniques designed to keep a situation from
escalating up the continuum. These stages of the use of force are spelled out in
training and are learned in practice. Officers develop their own methods and
find an area of specialization in which they feel most skilled.

"The reason all officers can't be CIT trained and certified is that not all have it in
them to be compassionate, especially with the mentally ill," said Officer Schafer.
"If somebody's just completely out of this world, you've got to learn how to talk
them down, talk them into the handcuffs and into the back seat of the squad
car. A police officer in uniform wearing a gun and a badge can look
intimidating. I begin by telling them I am Officer Schafer and to call me Mike."

A recent incident in which IDS might have been used illustrates the value of
CIT training. Officer Schafer tells of a man, upset over a relationship, who had
gotten a gun and was threatening to kill himself. "It's really dark. I am behind a
7- or 8-foot fence looking through a little crack, and he's on the back porch. I
was scared to death. He could have shot through the fence. First he didn't want
to talk. He was asking for a police officer he knew, and I continually said, 'I will
try to get in touch with him, but will you do me a favor and lay down the gun?'
But he didn't want to get separated from it. I told him we could not locate that
officer, but we were trying. You never want to lie, because not only could that
particular situation go bad if you lie, but you may have to answer a call there
again. I don't care if they are paranoid schizophrenic, manic, it doesn't matter--
that is in the training."

Officer Schafer continued, "He was concerned that I was going to have to
handcuff him like a criminal. I said, 'Anyone, I don't care if it's the President of
the United States, my policies and procedures say if you are in my back seat,
I've got to handcuff you.' But because he was embarrassed, I agreed to cuff
him in front. Finally he put down the gun, I put him in the car, and was gone. I
let other officers handle the gun. I took him to The Med because he had been
talking suicide. With people like that, it feels good because you made a
difference."

----------------------------

Use-of-Force Continuum

1. Physical presence.
2. Verbal warning.
3. Verbal command.
4. Chemical weapon.
5. Hands-on control (soft hands/ hard hands).
6. Impact weapons.
7. Deadly force.

----------------------------

Effects of the Program

Jail

Before the CIT program, officers responding to disturbing-the-peace or
misdemeanor calls would take the citizen directly to jail. This cast the homeless,
mentally ill, alcoholics, and drug abusers together; created an unsafe mix; and
clogged the court system. Now, people with mental illness who have committed
a misdemeanor or caused a disturbance go to jail only if they are considered by
the officer to be responsible for their own behavior. Otherwise they are
transported to The Med.

The jail accommodates between 400 and 700 prisoners. In Dr. Dupont's view,
screening by the medical ser-vice at the jail is not the best place to establish if
someone is mentally ill. They lack the resources to track those with a past
history of mental illness. When someone is brought to jail drunk or on drugs,
that condition may mask serious mental illness. When the person regains
sobriety, he or she may be in full psychosis and dangerous to other prisoners.

With CIT training, officers are able to recognize mental illness and provide
transport to The Med for triage. As a result, conditions have improved at the
jail by reducing the number of mentally ill individuals arrested. Dr. Dupont
acknowledges the importance of diverting additional individuals under the
influence to The Med instead of bringing them directly to jail because of the
increase in alcohol and drug use.

"I am not going to tell you that everything is wonderful in Memphis," said Lt.
Cochran. "We have all the problems of other cities. We are making great
efforts in getting people into The Med. And even if it is only 72 hours, that 72
hours of care is better than 72 hours in jail."

There is a separate locked facility for injured or ill prisoners at The Med. In the
case of less serious crimes, once aware of the consumer's psychiatric history,
the decision to press charges is often left to the victim.

----------------------------

Confronting Mental Illness

o Deinstitutionalization of the mentally ill resulted in many being abandoned.
o Quality-of-life initiatives often led to mentally ill individuals being arrested to
get them off the streets.
o Jails have become mental hospitals. Nationally there are 250,000 mentally ill 
prison inmates.
o 3.5 million Americans are afflicted with severe mental illness.
o 20 percent of Americans with severe mental illness are also mentally retarded.
o Mental illness is a disease, not a crime.

Updated statistical information may be found on the NAMI Web site
(www.nami.org/).

----------------------------

New Detox Center

Memphis is close to funding a detoxification unit at The Med. This facility is
intended to provide the missing link in the CIT network. It is being put in place
for both police and jail personnel who have difficulty making an accurate
preliminary diagnosis when alcohol or drugs are involved. The 300 intoxication
arrests made each month will be rerouted from the jail, helping to move the jail
out of the role of health-care provider. 

Critics

The Memphis CIT program has few critics, owing largely to its genesis from
community action. When all the constituents involved participate in creating the
program, they become invested in its success. Funding is always an issue, but it
does not have to be an impediment. People who support the CIT program may
be protective of funding for their own programs; those whose programs are not
funded can be resentful. The CIT program works because it is not about
money, but is about belief, ownership, and commitment among the partners.

Although some regular officers may feel that the CIT is a favored group within
the department, for the most part they seem to welcome CIT officers'
intervention in volatile, emotional situations involving someone not entirely "in
reality." When police have been called to a confrontational scene, they clearly
see the difference between cases appropriate to CIT handling and
commonplace law-breaking confrontations.

The CIT Program and New Initiatives

When asked what kept the momentum going as the CIT program was evolving,
Police Director Crews explained, "We had excellent leadership. Success
motivates success. Right now we make about 7,000 calls a year on the mentally
ill. And we have seen a dramatic decrease in injury (consumer and police) since
1988. It's not hard to multiply 7,000 by 11 years. CIT has just about put our
hostage negotiation team out of business. We've had only two or three hostage
situations in the past several years. That's not many if you consider that we
make over 73,000 police service calls a month overall."

The Memphis CIT program has had highly beneficial results including:

o Reduced stigma and perception of danger attached to mental illness.

o Increased involvement of officers on calls related to mental illness.

o Reduced use of deadly force.

o Reduced use of restraints.

o Fewer injuries to officers and citizens.

o Greater flexibility in the use of misdemeanor charges.

o Lower arrest rates.

o 2 1/2- to 3-percent decline in number of consumers sent to jail.

o Relief to an overburdened criminal justice system.

The benefits for The Med ER include:

o Officers' initial report of medical history better prepares doctors and nurses.

o Officers spend less time in ER.

o Patient violence has been reduced.

o The need for acute hospitalization has decreased from 40 to 25 percent.

o Health-care referrals have increased dramatically.

o Recidivism has decreased to less than 15 percent after 1 year.

All the members of the Memphis partnership believe the program is replicable
but must be tailored to the needs of the local community. Dr. Dupont noted, "In
larger cities there is so much ingrained heterogeneity in the systems that it's hard
to give the police a single source of entry as with The Med. You have to adapt
for that. In the smaller city you'd have to create a constellation of municipalities
to network into something where you have enough available for a facility,
perhaps a countywide draw."

To project success, a community wishing to create a Crisis Intervention Team
needs organizational intervention; sufficient political will to change the existing
public/governmental mindset and police culture; a mental health emergency
system capable of responding to the needs of police; a safe place for
consumers that is not jail; and a full understanding of the crisis team concept.

Currently, Lt. Cochran and Dr. Dupont are helping at least 50 other sites
nationwide assess their needs. Representatives of law enforcement agencies
from all over the country have been to Memphis, and requests for site visits
from scores more come in every day.

Epilogue

A month after the visit to Memphis for this Bulletin, an incident occurred that
received national news media attention. Responding to a 911 fire call, two
firefighters and a sheriff's deputy were shot and killed by a man who had
murdered his wife. In a telephone conversation about the incident, Lt. Cochran
was asked if CIT officers had been involved.

"No, they weren't," Lt. Cochran said. "It was an ambush situation; the whole
thing happened in a matter of seconds." 

"I'll tell you what though," Lt. Cochran continued, "last night CIT was called to
a Kroger's grocery store. A man who had refused to leave was by the bakery
section shouting. His attention was all over the place. When the police arrived,
he pulled out two pairs of long-bladed scissors. Holding a pair in each hand, he
started yelling, 'Kill me, Kill me!' at the officers. They tried talking to him, and
that didn't work. They tried pepper spray, and that didn't work. Finally when he
started coming at them waving the scissors saying, 'If you won't kill me, I'll kill
you,' from about 8 feet an officer shot him in the leg with one of the IDS lesser
energy rounds. He fell down, and they were able to subdue him and get him to
The Med. Now that's the way the Impact Delivery System is supposed to
work. It saved a life."

Consumers' names have been changed.

----------------------------

For More Information

For more information about the CIT program, contact:

Lt. Sam Cochran, Coordinator 
Crisis Investigation Bureau
Memphis Police Department
201 Poplar Avenue
Memphis, TN 38103-1947
901-545-5735
World Wide Web: www.memphispolice.org


Dr. Randy Dupont, Associate Professor
University of Tennessee-Memphis
College of Medicine
Department of Psychiatry
135 North Pauline, Suite 633
Memphis, TN 38105
901-448-4575
Fax: 901-448-4276

Helen Adano, Advocate
Alliance for the Mentally Ill
499 Patterson
Memphis, TN 38111
901-323-5928
Fax: 901-680-9327

Treatment Advocacy Center
3300 North Fairfax Drive, Suite 220
Arlington, VA 22201
703-294-6001
Fax: 703-294-6010
World Wide Web: www.psychlaws.org

National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Boulevard, Suite 300
Arlington, VA 22201-3042
1-800-950-6264

Fax: 703-524-9094
World Wide Web: www.nami.org

For more information about the Bureau of Justice Assistance and its programs,
contact:

Bureau of Justice Assistance
810 Seventh Street NW.
Washington, DC 20531
202-514-5943
World Wide Web: www.ojp.usdoj.gov/BJA

Bureau of Justice Assistance Clearinghouse
P.O. Box 6000
Rockville, MD 20849-6000
1-800-688-4252
E-mail: askncjrs@ncjrs.org
World Wide Web: www.ncjrs.org

Clearinghouse staff are available Monday through Friday, 8:30 a.m. to 7 p.m.
eastern time. Ask to be placed on the BJA mailing list.

U.S. Department of Justice Response Center
1-800-421-6770 or 202-307-1480

Response Center staff are available Monday through Friday, 9 a.m. to 5 p.m.
eastern time.

----------------------------

This series is dedicated to the exploration of vital issues in criminal justice
program development and management. Case studies highlight the work of
progressive, innovative people and programs in state and local criminal justice
systems. Although a case study may include a detailed description of the
operational aspects of a program, it is not a scientific program evaluation.
Rather, it is a document designed to explore the interaction of factors such as
collaboration, politics, resources, culture, and others that play a part in
successful public management.

----------------------------

Acknowledgments

The Bureau of Justice Assistance 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 the Office for Victims of Crime.

----------------------------

NCJ 182501
July 2000