Improving Responses to
People with Mental Illnesses
Tailoring Law Enforcement
Initiatives to Individual Jurisdictions

Bureau of Justice Assistance
U.S. Department of Justice

Improving Responses to
People with Mental Illnesses
Tailoring Law Enforcement
Initiatives to Individual Jurisdictions

A report prepared by the
Council of State Governments Justice Center
and the Police Executive Research Forum
for the
Bureau of Justice Assistance
Office of Justice Programs
U.S. Department of Justice

Melissa Reuland
Laura Draper
Blake Norton

This report was prepared by the Council of State Governments Justice Center, in partnership with the Police
Executive Research Forum. It was completed under cooperative agreement 2005–MU–BX–K208 awarded by
the Bureau of Justice Assistance.
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. The opinions and findings in this document do not necessarily
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.
The Bureau of Justice Assistance 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.
Websites 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
© 2010 by the Council of State Governments Justice Center
Cover based on design by Nancy Kapp & Company. Interior design by David Williams.

Contents

Acknowledgments
Introduction

v
vii

Section I—Step by Step: The Program Design Process

1

Step 1: Understand the problem

3

Step 2: Articulate program goals and objectives

6

Step 3: Identify data-collection procedures
needed to revise and evaluate the program

7

Step 4: Detail jurisdictional characteristics and
their influence on program responses

9

Step 5: Establish response protocols

11

Step 6: Determine training requirements

15

Step 7: Prepare for program evaluation

17

Section II—From the Field: Program Design in Action

19

Tailoring Specialized Policing Response Programs
to Specific Problems

19

Tailoring Specialized Policing Response Programs to
Jurisdictional Characteristics

34

Appendix A: Site Visit Information

45

Appendix B: Document Development

49

Appendix C: Program Design Worksheet

51

Acknowledgments
This report could not have been written without the leadership and support of the Bureau of
Justice Assistance (BJA), Office of Justice Programs, U.S. Department of Justice, particularly
from Ruby Qazilbash, Senior Policy Advisor for Substance Abuse and Mental Health, and
Rebecca Rose, Policy Advisor for Substance Abuse and Mental Health. They expertly guided
this document from start to finish.
The law enforcement and mental health professionals involved in each of the site visits
provided the substance and “lessons learned” that make this report of true value to the
field. Their commitment to improving the law enforcement response to people with mental
illnesses is tremendous, and their willingness to share their experiences has resulted in a
practical and user-friendly publication. Thanks are due to all those who met with the Council
of State Governments (CSG) Justice Center project staff on site, and provided feedback on the
document during various stages of its development. Special thanks go to the representative
from each jurisdiction who helped coordinate each visit and scheduled the interviews with
local stakeholders:*
• Victoria Cochran, Virginia State Coordinator for Criminal Justice and Mental Health
Initiatives
• Deputy Chief Dottie Davis, Director of Training, Fort Wayne (Ind.) Police Department
• Captain Richard Wall, Los Angeles (Calif.) Police Department
• Sergeant Michael Yohe, CIT Coordinator, Akron (Ohio) Police Department
(A complete list of contributors, by jurisdiction, can be found in appendix A.)
There are also many agency representatives who participated in informative—and
sometimes lengthy—phone interviews, providing project staff with details about how they
tailored their law enforcement response program to often complex circumstances and
demands. These initial interviews, involving key personnel from the following departments,
provided a wealth of information, and assisted in the planning and conceptualization of the
project.
• Baltimore County (Md.) Police Department
• Birmingham (Ala.) Police Department
• City of Lorain (Ohio) Police Department
• Fort Lauderdale (Fla.) Police Department
• Houston (Tex.) Police Department
• Jackson County (Mo.) Sheriff’s Office
• Jacksonville (Fla.) Sheriff’s Office
• Kansas City (Mo.) Police Department

*Representatives’ titles and agency affiliations reflect the positions they held at the time this document was
published, which may differ from titles listed in appendix A.

Acknowledgments

v

•
•
•
•
•
•
•
•

Lees Summit (Mo.) Police Department
Lincoln (Nebr.) Police Department
Long Beach (Calif.) Police Department
Montgomery County (Md.) Police Department
New London (Conn.) Police Department
Portland (Ore.) Police Bureau
Portland (Maine) Police Department
San Diego (Calif.) City Police and County Sheriff’s Department

The authors thank Justice Center Communications Director Martha Plotkin, Director
Mike Thompson, and Health Systems and Services Policy Director Fred Osher for their
insights in helping shape the scope and direction of this publication. Communications
Deputy Director Regina L. Davis also contributed her well-honed editing skills. In addition,
the authors appreciate the ongoing support that the Police Executive Research Forum’s
Executive Director, Chuck Wexler, has lent this project and so many that affect the most
vulnerable individuals who come into contact with law enforcement.

vi

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Introduction
A growing number of law enforcement agencies have partnered with mental health agencies
and community groups to design and implement innovative programs to improve encounters
involving people with mental illnesses. These “specialized policing responses” (SPRs) are
designed to produce better outcomes from these encounters by training responders to use
crisis de-escalation strategies and prioritize treatment over incarceration when appropriate.1
Effective SPRs share many common features, but programs also differ in some important
ways. These programmatic variations generally stem from a community’s unique needs,
opportunities, and limitations. For example, officers in rural areas may have difficulty
connecting people to a full range of mental health services, whereas officers in large urban
areas may spend hours out of service trying to transport people to mental health facilities
through traffic-congested areas. Some jurisdictions may spend tremendous resources
responding repeatedly to a small number of locations or individuals. Other communities may
face significant concerns about responding appropriately to particular groups of individuals,
such as people with mental illnesses who are homeless.

spotlight

Different Jurisdictions,
Different Program Models

Two of the most common law enforcement-based specialized response programs are the Crisis
Intervention Team (CIT) model and the co-responder model. Each program model was developed
based on a jurisdiction’s unique circumstances, reflecting the need for a flexible decisionmaking process.
Memphis (Tenn.) police leaders, mental health professionals and advocates, city hall
officials, and other key stakeholders were spurred to action following a tragic incident in which
an officer killed a person with a mental illness. In response, the Memphis Police Department
established the first law enforcement-based CIT in 1988, which was designed to improve
safety during these encounters by enhancing officers’ ability to de-escalate the situation and
providing community-based treatment alternatives to incarceration.
Los Angeles and San Diego (Calif.) initiative leaders recognized that officers encountered
many people with mental illnesses who were not engaged with treatments and services.
To address this problem, law enforcement agencies collaborated with the mental health
community to form teams in which officers and treatment professionals respond together at
the scene to connect these individuals with community-based services more effectively.

1. There has been a trend toward categorizing any response in which law enforcement plays a central role in
addressing people with mental illnesses as a “crisis intervention team (CIT)” approach. To avoid confusion, this
publication refers to all law enforcement-based responses as “specialized policing responses” or SPRs (pronounced
spurs). The term encompasses both “CIT “and “co-responder” approaches. Those terms can then be preserved to
describe accurately the scope and nature of those models.

Introduction

vii

Law enforcement agencies have identified a variety of ways to respond that recognize the
unique opportunities and limitations presented by each of their jurisdictions. Some agencies
have replicated existing models from other jurisdictions—such as the Memphis CIT Model—
to improve their responses to people with mental illnesses. Other agencies have determined
that specific community characteristics and law enforcement resources (for example, the
lack of a single mental health facility or the tremendous size of a policing agency) require
adaptations and additions to existing models—such as implementing a mental health
outreach team in addition to an existing CIT program.
To determine the best possible response model that will meet local needs, each
jurisdiction should work through a program design process. This is not to say that they
should reinvent the wheel, but rather they should not skip the critical program planning and
development steps that ensure a program will reflect their unique community characteristics.
Program design decisions should be made in the context of a collaborative planning process
that includes a wide variety of stakeholders—a practice that most communities committed
to specialized responses undertake.2 Beyond a commitment to collaboration, however, little
is known about the steps law enforcement professionals and community members take to
tailor other jurisdictions’ models to their own distinct problems and circumstances. This
publication addresses that gap and provides guidance for jurisdictions that want to improve
their law enforcement interactions with people who have mental illnesses.

About this Report
This report is the result of a project supported by the Bureau of Justice Assistance (BJA),
U.S. Department of Justice. It explores the program design process, including detailed
examples from several communities from across the country.3 It is meant to assist initiative
leaders and agents of change who want to select or adapt program features from models
that will be most effective in their communities. To ensure that this material has practical
value, staff members from the Council of State Governments (CSG) Justice Center and the
Police Executive Research Forum (PERF) visited four jurisdictions with extensive experience
with SPRs to examine their decision-making and program development processes (selected
based on a range of characteristics such as diverse objectives, jurisdiction size, and program
model type).4 During each visit, project staff interviewed relevant stakeholders and observed

2. Throughout this document, the term “stakeholders” is used to describe the diverse group of individuals
affected by law enforcement encounters with people with mental illnesses, such as criminal justice and mental
health professionals; myriad other service providers, including substance abuse counselors and housing
professionals; people with mental illnesses (sometimes referred to as “consumers”) and their loved ones; crime
victims; and other community representatives.
3. The examples included in this guide reflect various types of efforts that involve partnerships, programs,
or practices for other communities to consider as they develop responses to people with mental illnesses. By
highlighting this sampling of approaches, however, the authors are not necessarily promoting them as “best
practices.”
4. For information on when the site visits were conducted and the personnel interviewed, see appendix A.
This document also includes program examples from several other jurisdictions interviewed but not visited for
this project, as well as several communities that have received grants through BJA’s Justice and Mental Health
Collaboration Program (JMHCP). See www.ojp.usdoj.gov/BJA/grant/JMHCprogram.html for more information
about JMHCP.

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Tailoring Law Enforcement Initiatives to Individual Jurisdictions

initiative activities.5 The four jurisdictions selected were Akron, Ohio; Fort Wayne, Ind.; Los
Angeles, Calif.; and New River Valley, Va.
This report is divided into two sections: 1) Step by Step: The Program Design Process,
and 2) From the Field: Program Design in Action. The first section articulates the seven steps
involved in shaping a program that best address a jurisdiction’s distinct resources and needs,
and within each step provides questions to help guide the planning process. This section is

spotlight

About the Four Sites

Akron (Ohio) provides an example of a program that has remained true to the Memphis
model of a Crisis Intervention Team (CIT), transplanting it to a new jurisdiction. This agency
has collected a substantial amount of data, which has shown this program to be an effective
solution to its jurisdictional needs. Agency representatives identified the need to augment CIT
with follow-up program activities to address a broader range of problems in their jurisdiction.
Fort Wayne (Ind.) operates a traditional CIT program with a focus on schools and
juveniles. School Resource Officers (SROs) are trained to recognize and respond to a range of
self-destructive behaviors (such as self-mutilation), and CIT officers coordinate with school
administrators to identify youth who would be best served by mental health services rather
than the juvenile justice system. Data collection processes are advanced and thorough, which
allows program policymakers to evaluate the initiative’s progress.
Los Angeles (Calif.) has implemented a wide variety of adaptations to address the unique
needs of its jurisdiction, focusing on a co-responder model, while incorporating elements of
the CIT model into patrol operations, as well as creating a new program focusing on a priority
population. Their experience illustrates the difficulties some large jurisdictions have had in
implementing the CIT model citywide. Due to its sheer size, both in area and in population,
the CIT approach alone did not effectively address the community’s problems. In response, the
department believes it developed a more robust and multifaceted strategy.
New River Valley (Va.) represents a rural, multi-jurisdictional CIT program that includes
fourteen different law enforcement agencies contained in four counties and one city.6
The challenges facing these non-urban communities and the state law requiring that law
enforcement take custody of a person meeting the criteria for an emergency mental health
assessment have led to the need for several adaptations to the CIT model.
For more information on how these sites were selected, see appendix B.

5. Some practitioners are concerned that law enforcement not just conduct “programs” that are a discrete set of
activities, instead stressing that agencies should develop broader “initiatives” in which an agency engages in a
comprehensive effort that includes meaningful partnerships with the community and other agencies. Because
practitioners in the field used these terms interchangeably in interviews, this report also uses both to refer to
efforts to improve responses to people with mental illnesses and instead qualifies or describes the level of agency
engagement and commitment from a community.
6. The fourteen law enforcement agencies that comprise the New River Valley (NRV) CIT are the Blacksburg
Police Department, Christiansburg Police Department, Dublin Police Department, Floyd County Sheriff’s Office,
Giles County Sheriff’s Office, Montgomery County Sheriff’s Office, Narrows Police Department, Pearisburg Police
Department, Pulaski Police Department, Pulaski County Sheriff’s Office, Radford City Police Department, Radford
City Sheriff’s Office, Radford University Police Department, and Virginia Tech Police Department.

Introduction

ix

most useful for policymakers and practitioners interested in learning how to design or revise
a program—whether it is a CIT, a co-responder model, or some combination or variation of
these models—that takes into full account the specific factors that drive their jurisdiction’s
problems associated with law enforcement interactions with people who have mental
illnesses.
The second section provides two overview charts—one about problems that affect
program design and the other about jurisdiction characteristics that can affect initiative plans.
It also provides specific examples that illustrate how program design processes are translated
into activities in the field, drawing on information provided during interviews and site visits.
It describes how program elements are tailored to a jurisdiction’s problems and specific
characteristics when implemented.
The information collected from the four sites reveals a blurring of the two main models.
In some cases, it is not possible to use the terms “CIT” or “co-responder” to describe the
entirety of a jurisdiction’s responses; communities are now implementing a combination of
both approaches. This section will help individuals interested in learning more about how
other agencies throughout the country have navigated the program design process to develop
these evolving initiatives.
As discussed more fully below, this report delves into some of the other ten “essential
elements” of a successful SPR to people with mental illnesses that are identified and outlined
in a previous publication.7 Whenever applicable, references to these elements are highlighted
in the text. The material that follows also includes sidebar articles on related topics that often
include references to additional sources of information.

Related Resources
This publication is just one in a series that addresses how law enforcement responds to
people with mental illnesses. The Justice Center, in partnership with PERF and with support
from BJA, has developed a collection of resources for law enforcement practitioners and
their community partners.8 The centerpiece of the Improving Responses to People with Mental
Illnesses suite of materials is the publication, The Essential Elements of a Law Enforcement-Based
Program.9 The other documents build on this essential elements publication. For example,
one of the ten essential elements describes the need for specialized officer training that is
tailored to the law enforcement audience. It is a very concise description of why training
is needed and highlights some key challenges to overcome. Another publication, Strategies
for Effective Law Enforcement Training, explores these training issues in greater depth and

7. Readers are encouraged to review Improving Responses to People with Mental Illnesses: The Essential Elements of
a Specialized Law Enforcement-Based Program to better understand how program design and decision making fit
within a broader context. To download a copy, visit www.consensusproject.org/issue_areas/law-enforcement.
8. The project and publication were completed as part of BJA’s Law Enforcement/Mental Health Partnership
Program. The resources developed as part of this suite of materials are available for free download at the law
enforcement issues page on the Justice Center’s Consensus Project website (www.consensusproject.org).
9. The ten essential elements presented in this document are Collaborative Planning and Implementation;
Program Design; Specialized Training; Call-Taker and Dispatcher Protocols; Stabilization, Observation, and
Disposition; Transportation and Custodial Transfer; Information Exchange and Confidentiality; Treatment,
Supports, and Services; Organizational Support; and Program Evaluation and Sustainability.

x

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

raises additional matters that must be considered in training law enforcement officers. This
document’s focus on tailoring specialized responses provides a similar level of discussion
and guidance for readers who want to drill down to the details and implementation options
for the essential element that encourages thoughtful, collaborative program design. These
written materials are complemented by web-based information on statewide efforts to
coordinate law enforcement responses and by an online Local Programs Database.10

Essential
Element

2

Program Design11
The planning committee designs a specialized law enforcement-based
program to address the root causes of the problems that are impeding
improved responses to people with mental illnesses and makes the most
of available resources.

10. The Local Programs Database, formerly referred to as the Criminal Justice/Mental Health Information
Network (InfoNet), was made possible through the leadership, support, and collaboration of key federal
agencies and private foundations, including the Bureau of Justice Assistance (BJA) and the National Institute of
Corrections (NIC). The database was created to foster peer-to-peer learning among agencies across the country.
The database is interactive and entries include contact information to facilitate information sharing, as well
as easily searchable fields on key topics. The database is available through the Consensus Project website at
www.consensusproject.org and can be searched for information on other programs or accessed to create a new
program profile.
11. This and other elements reflect a consensus of experts, including a broad range of policymakers,
practitioners, advocates, and researchers, whose recommendations are captured in the Essential Elements report.

Introduction

xi

Section I
Step by Step:
The Program Design Process
Designing a program specific to a community’s unique needs is a complex process.
Identifying and implementing a collaborative partnership is the first hurdle, but once
stakeholders are involved and committed to the issue, the question remains, “What next?”
It is critical that a planning committee (and its program coordination group) develop
a strong level of collaboration among stakeholders, yet the process can be fraught with
significant challenges. Personnel from the four featured sites shared how they have
successfully engaged people who are vested in the outcomes of law enforcement interactions
involving people with mental illnesses and established lasting frameworks to maintain their
programs’ integrity. The keys to their success include the following:
• Gain the support of law enforcement leaders through the involvement of other law
enforcement leaders. In deciding whether to participate in the New River Valley CIT
program, the Chief of the Pearisburg (Va.) Police Department was influenced by both
the chief law enforcement executive in Radford (Va.) and Major Sam Cochran, the
former CIT Coordinator for the Memphis (Tenn.) Police Department, who were each
able to explain—from one law enforcement official to another—the importance and
benefits of specialized responses to people with mental illnesses.
Essential
Element

Collaborative Planning and Implementation

Organizations and individuals representing a wide range of
disciplines and perspectives and with a strong interest in improving
law enforcement encounters with people with mental illnesses work
together in one or more groups to determine the response program’s
characteristics and guide implementation efforts.

1

Keys to Collaboration
The planning committee is composed of leaders from each of the stakeholder
agencies who have operational decision-making authority and community
representatives. This executive-level committee should examine the nature of
the problem and help determine the program’s objectives and design.
The program coordination group is made up of staff members from
stakeholder agencies. This group should oversee officer training, measure
the program’s progress toward achieving stated goals, and resolve ongoing
challenges to program effectiveness.
In some jurisdictions, the two bodies may be the same—particularly those
with small agencies, in rural areas, or with limited resources.
Step by Step: The Program Design Process

1

• Develop a subcommittee structure within the larger planning committee or program
coordination group to support targeted issue areas and make collaboration more
efficient. In addition to their participation in a multidisciplinary coalition in the New
River Valley CIT program, initiative planners developed a “Law Enforcement and Mental
Health Services Coalition,” which meets quarterly to discuss mental health issues
related specifically to law enforcement. In Fort Wayne (Ind.), a subcommittee composed
of individuals from law enforcement, mental health, and advocacy meets separately to
focus on training development and then to prepare and host training sessions several
times each year. The training committee in Akron (Ohio), which meets twice yearly,
manages the iterative process of refreshing the curriculum to ensure it reflects the most
current policies and procedures.
• Designate staff members to focus on accountability and to maintain connections among
stakeholders in the collaboration. The planning committee can designate staff members
in the program coordination group to manage the logistics of partnerships. Identified
personnel can ensure that there is an emphasis on collaboration from the start of the
program.
• Exchange meaningful information to measure outcomes and foster necessary program
changes. Stakeholders will be more likely to maintain their involvement if they find
the meetings provide meaningful information and accomplish specific tasks. In Los
Angeles, the police department shares information with its mental health advisory board
about their use-of-force trends and reports, for example.

What Next, After Collaboration?
This section outlines seven key steps involved in the collaborative program design process.
Each step includes a series of questions designed to help planning and coordination groups
structure their discussions and advance their thinking about related issues.12
Step 1: Understand the problem
Step 2: Articulate program goals and objectives
Step 3: Identify data-collection procedures needed to revise and evaluate the program
Step 4: Detail jurisdictional characteristics and their influence on program responses
Step 5: Establish response protocols
Step 6: Determine training requirements
Step 7: Prepare for program evaluation
In each of the four jurisdictions—Akron, Fort Wayne, Los Angeles, and New River
Valley—initiative leaders found that the challenges their community faced were inter-related,
multilayered, and required similarly complex and nuanced responses. In addition, those

12. For a worksheet that provides the questions that guide the design process without the narrative explanation,
see appendix C.

2

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

who had created programmatic responses found that it was an iterative process, rather than
a simple linear approach. Accordingly, the steps recommended in this guide are designed to
be revisited as needed to fine-tune efforts and remain responsive to conditions and resources
in a jurisdiction. Program design does not end when the seven steps are complete, but rather
requires an ongoing effort to evaluate and adjust program responses as the community’s
landscape changes.

Step 1:

Understand the problem13
Program development is often initiated in reaction to a
terrible tragedy in the community, impending litigation, or
another event. Partners involved in the collaboration should
start the program design process by researching and then
moving beyond the initial impetus to develop a common
and comprehensive understanding of the legal, clinical,
and community circumstances that make it so challenging
to effectively respond to people with mental illnesses
encountered by law enforcement officers.
It is important to stress from the outset that research
does not support the stereotype that people with mental
illnesses are more violent than individuals in the general
population.14 Accordingly, police use of force is usually not
needed. Yet even though the occurrence is infrequent for
there to be law enforcement shootings involving people with
mental illnesses, the impact of such events on the officer,
the individual’s family, and the community—and even on
other communities not directly involved—is profound and

We ask ourselves, and other
agencies ask, too, would these
terrible incidents have happened
[where someone is shot and
killed] had this program been
in place at that time? We paid
a terrible price. Why would an
agency choose to do otherwise?
How could they see what has
happened here and in LA County
and knowingly choose not to do
this program? It makes no sense
to me.”
—Assistant Chief
Earl Paysinger
Director, Office of Operations,
Los Angeles (Calif.) Police Department

13. Gary Cordner’s report “People with Mental Illness” also emphasizes the need for decision-makers to
understand the problem in their local community to design an effective response strategy. He provides detailed
questions that planners should ask to better understand the impact of incidents, stakeholders, victims,
offenders, and locations/times. Gary Cordner, “People with Mental Illness,” Problem-Oriented Guides for Police
Problem-Specific Guides Series, Number 40, U.S. Department of Justice (Washington, DC: Office of Community
Oriented Policing Services, 2006), www.popcenter.org/problems/mental_illness.
14. For a scholarly review, see A. Harris and A.J. Lurigio, “Mental illness and violence: A brief review of
research and assessment strategies,” Aggressive and Violent Behavior 12(5) 2007: 542–51. Several large-scale
research projects found a weak statistical association between mental illness and violence (M.C. Angermeyer,
B. Cooper, and B.G. Link. “Mental disorder and violence: Results of epidemiological studies in the era of
deinstitutionalization,” Social Psychiatry and Psychiatric Epidemiology 33(13) 1998: S1–S6). The association becomes
stronger, however, when a person with a mental illness has a co-occurring substance use disorder and/or is not
taking his or her medication (H.J. Steadman, E.P. Mulvey, J. Monahan, P.C. Robbins, P.S. Appelbaum, T. Grisso,
L.H. Roth, and E. Silver, “Violence by people discharged from acute psychiatric inpatient facilities and by others in
the same neighborhoods.” Archives of General Psychiatry 55 1998: 393–401; M.S. Swartz, J.W. Swanson, V.A. Hiday,
R. Borum, H.R. Wagner, and B.J. Burns. “Violence and severe mental illness: The effects of substance abuse and
nonadherence to medication,” American Journal of Psychiatry 155 1998: 226–31).

Step by Step: The Program Design Process

3

far-reaching. The following questions can prompt planners to investigate the scope and
nature of the challenges officers face in incidents involving people with mental illnesses
and design appropriate responses.
Question 1: What forces are driving current efforts to improve the law

enforcement response to people with mental illnesses?
Stakeholders should contribute their individual perspectives to answer this question.
Law enforcement line staff may voice concern about the many challenges they face
during encounters involving people with mental illnesses—many agree that these calls
are often time-consuming and frustrating. Patrol officers may spend long periods of
time attempting to link a person in crisis to an appropriate mental health resource,
and also may find themselves responding repeatedly to the same individuals without
seeing any improvement in the outcomes. From another perspective, consumers of
mental health services and their families might identify the need for change because of
the limited treatment and response options for people with mental illnesses at risk of
criminal justice involvement. They may not have any other options when a loved one
is in crisis, but are disappointed by the results of law enforcement engagement. Both
stakeholder groups would likely agree that the person’s mental health and related calls
for service are not improved through the more traditional interactions with police. It
is important both to recognize the legitimacy of each argument and the need to reach
consensus around the issues influencing the reasons for change. (Section II of this
report provides more detail about the specific problems and the contributing factors
that various jurisdictions have encountered.)
Question 2: What data can planning committee members examine to understand

the factors influencing law enforcement responses to people with mental
illnesses?
Effective program design hinges on accurately identifying the causes of the problems
communities face. For example, if a community is responding to a tragic incident,
stakeholders must explore the circumstances that led up to and occurred during the
incident. They will also want to look for more systemic issues that go beyond those
involved in the particular incident. This exploration may include interviews with the
involved parties and a review of law enforcement and mental health system protocols
and procedures (including response practices and training), as well as an assessment of
resource gaps that may be hindering better responses to people with mental illnesses.
Among the law enforcement data that should be considered when defining the
scope and nature of the problem are the number and types of calls related to people
with mental illnesses, duration of the responses, and related use-of-force information.
It may be important to note whether officers are responding repeatedly to the same
individuals and locations to determine if interventions are needed to produce better
results. One option is to examine computer-aided dispatch (CAD) data. If possible,
efforts should be made to understand outcomes of calls for service through forms used
to track the disposition of calls.

4

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Valuable information should also be gleaned about the mental health system
response. For example, planners can review the number and type of admissions at
the receiving psychiatric facilities, and gather feedback on this process from officers,
mental health professionals, family members, and consumers that has been collected
through focus groups, surveys, or interviews.15 Data should be collected on how long
officers spend at the mental health facility and problems experienced in transferring
custody as well. It is also important to catalog the types of services provided by
community mental health centers and other providers, their availability, and their
capacity to address the individuals’ needs. Together, this information can then inform
needed changes in responses.
(Problems that are related to community and agency characteristics, such as lack of
mental health resources uncovered by cataloging the number and kind of available
providers and their admission criteria, are addressed in Step 4: Question 2.)
Question 3: What are the data limitations, and how can they be overcome?
Stakeholders should identify the limitations of various data sources, such as the
scant reporting on perceived mental illness in CAD databases or the failure of
mental health intake records to account for the involvement of law enforcement. Law
enforcement and community stakeholders should explore why officers may not be
reporting encounters they resolve at the scene, what system limitations there are that
make it difficult to capture relevant information when clearing a call or ending a field
interaction, and other problems with gathering information on these interactions.
Efforts should be made to resolve these issues and gain a better understanding of
whether repeat calls for service, or particularly difficult incidents, center on a particular
subgroup of individuals, such as people in a particular beat, men with substance abuse
problems, or women who are homeless.
A critical component of the program design process is to ensure that goals,
objectives, policy and practice reforms, and measures of success are all data-driven
and tailored to a particular jurisdiction’s distinctive needs. Because of problems with
underreporting and other collection barriers mentioned previously, data should be
interpreted with these limitations in mind. They are, however, still useful sources of
information that provide a starting point for program design. To enhance the reliability
of the information, stakeholders should consult multiple sources of data.

15. “Receiving psychiatric facilities” include all medical facilities that will receive, assess, and treat someone
in a mental health crisis, including hospital emergency rooms, psychiatric hospitals, and crisis drop-off
centers. Most medical information is protected under federal and state privacy laws. If stakeholders wish to
examine protected health information during this process, they should take into account laws governing
this information exchange. For an overview of the federal laws, see John Petrila, “Dispelling the Myths about
Information Sharing between the Mental Health and Criminal Justice Systems,” National GAINS Center for
Systemic Change for Justice-Involved People with Mental Illness (February 2007). Petrila also participated in a
webinar, “HIPAA: Myths, Facts, and Cross-systems Collaboration” (March 23, 2009). The associated presentation
is available at www.consensusproject.org/features/hipaappt.

Step by Step: The Program Design Process

5

Step 2:

Articulate program goals and objectives
Once the collaborative planning group has a firm grasp on the challenges facing the
community, they should establish the program’s goals and objectives. Program goals
capture the “big picture” of the good that the effort is meant to achieve, whereas
objectives outline program activities that, if achieved, would meet those goals. A shared
statement of the program goals will advance the discussion around program design. The
objectives will not only detail the mechanisms for achieving a program goal, but will
also provide a framework for developing evaluation measures. Program planners should
articulate realistic goals and objectives, and avoid terminology that suggests problems
will be “eliminated” or that all individuals will benefit from improved responses. It is
advisable to establish both short- and long-term goals and objectives to help ensure early
successes and sustainability.
Question 1: What are the program’s overarching goals?
The program’s goals reflect the desired outcome of the initiative on the primary problems
identified by the planning group and other stakeholders in the community. For example,
if the community is responding to a tragic incident involving law enforcement and a
person with mental illness, the program goals might include improving officer and
community safety. The goals should be well-articulated in writing and shared among all
partners and the community, and should be reviewed periodically.
Other goals might include reducing arrests for minor offenses, lowering the number
of repeat calls for service involving people with mental illnesses, decreasing the use
of force by law enforcement, incurring fewer injuries among all involved at the scene,
increasing the numbers of people diverted to mental health treatment when warranted,
or cutting law enforcement agency costs.
Question 2: What are the program’s objectives?
Objectives capture the specific program activities needed to achieve the stated goals. For
example, if stakeholders identify improved safety as the program goal, providing effective
agency training on de-escalation will be a key program objective. Objectives should be as
specific as possible. In this example, the objective could be to train a certain proportion of
the primary and secondary responders or a particular subset of individuals.16 If the goal
is to address strains on law enforcement resources, one objective might be reducing the
amount of time officers spend attempting to link people with mental illnesses to mental
health services to a target number (for example, 15–30 minutes).

16. Examples that include specific numbers or percentages included in this section are not intended as
recommendations, but are included only to highlight the value of setting specific goals within the agency
to monitor improvement and to evaluate the extent to which the program is implemented.

6

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Step 3:

Identify data-collection procedures needed to revise
and evaluate the program17
Once program goals and objectives are set, law enforcement and their partners can use
them to identify what information they should collect and how they should collect it.18
Data collection practices should take into account both process and outcome measures.
Evaluating a program’s process will allow coordinators to assess whether the proposed
activities are being carried out (how many individuals were trained, how many calls
were answered by an officer with training, and more) so planners can revise day-to-day
program functioning and the reach of the initiative. It is also critical that the evaluation
determine whether the activities are having the intended outcome (that is, the impact
that planners hoped to achieve for people with mental illnesses, officers, and the
community)—information needed not only to assess true advances, but also to secure
funding and ensure program sustainability over time.
Question 1: What data will be collected to measure whether goals and objectives

have been achieved?
Once goals and objectives have been articulated clearly, determining what information
is required to measure them will be generally straightforward. For example, if a goal
is to increase safety, an agency would want to collect data on injuries or deaths, use of
force, and citizen complaints to see if that has been attained. If a related objective is to
train all recruits, the agency or its partners will need to track the number of recruits
who complete the curriculum or successfully pass a test. Most initiatives will want to
address many of the issues raised previously that relate to using scarce law enforcement
resources to better identify and safely serve people with mental illnesses—particularly
those who should appropriately be diverted to the mental health system. Accordingly,
the collaborative planning group and other stakeholders will want to collect data such as
the frequency of calls for service involving people with mental illnesses, including how
many are to the same individuals or locations; the types and frequency of disposition
decisions; the percentage of calls that specially trained personnel handle and the portion
that involve routine responses, and the duration of those responses; and any injuries
or fatalities suffered during law enforcement encounters involving people with mental
illnesses.

17. Cordner’s “People with Mental Illness” provides additional information on measures that could be used to
evaluate the effectiveness of the SPR. Cordner, “People with Mental Illness.” For a detailed guide to program
evaluation, consult such resources as Richard A. Berk and Peter H. Rossi, Thinking about Program Evaluation 2
(Thousand Oaks, CA: Sage Publications, 1999); Robert H. Langworthy, ed. Measuring What Matters: Proceedings from
the Policing Research Institute Meetings, (Washington, DC: U.S. Department of Justice, National Institute of Justice,
1999); Kristin Ward, Susan Chibnall, and Robyn Harris. Measuring Excellence: Planning and Managing Evaluations of
Law Enforcement Initiatives (Washington, DC: U.S. Department of Justice Office of Community Oriented Policing
Services, 2007).
18. Law enforcement agencies may want to partner with a local college or university to assist with identifying
what data to collect. Academic partners should be included from the beginning of the planning stages to provide
guidance during this step.

Step by Step: The Program Design Process

7

Question 2: What data collection strategies will be used?
Many existing data sources—such as CAD data,
Emergency Medical Services (EMS) logs, and
Emergency Room records—can provide useful
information. These data systems typically were
designed, however, to capture information for purposes
other than law enforcement/mental health program
improvement or evaluation. As a result, specialized law
enforcement-based programs almost always require
collecting new information, and often from different
sources or in novel ways.

Every time there is a CIT
encounter, there is a stat
sheet completed. This
is a police department
document, which can be
shared internally and also
with mental health partners.
These sheets are used to
identify problems so we can
address them.”

Collecting the necessary information has proven
—Dr. Mark Munetz
difficult for many agencies. Each of the four agencies
Chief Clinical Officer, Summit
County (Ohio) Alcohol, Drug
featured in this report had varying levels of success
Addiction and Mental Health
capturing data consistently from both law enforcement
Services Board
officers and mental health providers. The two major
limitations are 1) inconsistency in call identification
and 2) paperwork noncompliance. Most agencies do not have a reliable method to label
calls for service involving people with mental illnesses at the time of dispatch, nor an ability
to update the codes in the CAD system retroactively to reflect new information relating
to mental health status.19 In terms of noncompliance with record-keeping or reporting
practices, law enforcement officers have an enormous amount of paperwork to complete for
all incidents, particularly those involving serious crimes or arrests, and may feel that the time
needed to complete an additional form is in conflict with their other policing duties. Both of
these factors can result in missing or incomplete data in law enforcement systems. Mental
health providers may also experience problems with trying to maintain updated, accurate
information in their systems given their often overwhelming caseloads. Departments must
be creative and persistent in overcoming these challenges.
PROGRAM EXAMPLE: Addressing barriers to data collection, Philadelphia (Pa.)
In 2006, Philadelphia received a Justice and Mental Health Collaboration Program (JMHCP)
grant from the Bureau of Justice Assistance. Initiative leaders decided to use this funding to
plan and implement a CIT program in the Philadelphia Police Department—pilot-testing the
program in a single division and addressing any challenges before expanding it departmentwide.
According to coalition members, one of the main difficulties the planners faced was obtaining information directly from the CIT officers about their encounters with people with mental
illnesses. In response, they decided to change their data-reporting system from a paper-based
system to a call-in system. At this writing, officers call the CIT coordinator to complete the
necessary form by phone, and then the coordinator collects and files the reports.
For more information about Philadelphia’s program, see the program entry in the Local
Programs Database available at www.consensusproject.org.

19. The majority of police action related to people with mental illnesses in the four sites studied was based on
responding to calls for service rather than incidents observed during the course of routine patrol.

8

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Step 4:

Detail jurisdictional characteristics and their influence
on program responses
For this discussion, “jurisdictional characteristics” refers to those aspects of a community
that are difficult to change, often requiring long-term efforts. Based on information
gathered during the site visits, project staff found these characteristics fall into four
categories relating to 1) the law enforcement agency, 2) the mental health system,
3) state laws, and 4) geography and demography. Each of these categories should be
considered when designing a program.
Question 1: What characteristics of the law enforcement agency are relevant in

planning a specialized response to people with mental illnesses?
The planning group and stakeholders should consider the
following during the design stage:
• Agency resources, which include staffing levels, data
management structures, training expertise and capacity,
and availability of less-lethal technologies.
• Relevant policies and regulations, such as use-of-force
guidelines, discretion in making arrests, policies on
diversion, reporting requirements, information-sharing
policies, and requirements for handcuffing during
custodial transport.
• Leadership styles, which may dictate the number of
officers a program seeks to train, either focusing on a
small self-selecting group or providing training to an entire
department. Some law enforcement executives believe
a subset of officers must become “specialists” who are
dedicated to particular areas of expertise (such as domestic
violence) because the additional information they obtain
will help them respond to those situations more effectively.
Other chiefs or agency executives believe all officers
should be prepared to respond to all situations they will
encounter. Leadership must believe there is a compelling
need to prioritize limited resources to address this issue.
And they must be willing to designate someone within the
agency to help provide oversight and support to the effort,
to work collaboratively with the mental health community,
and to garner support among policymakers to ensure
sustainability. The agency should have leaders who are
willing to even reconsider officer evaluation criteria that is

I talk about the
three Cs of program
success: compassion,
constitutionality, and
consistency. Compassion
is brought by people
who want to be [in a
specialized assignment].
Constitutionality and
consistency are greatly
enhanced when the
department provides
resources.”
—Chief William Bratton
Los Angeles (Calif.)
Police Department

Working on the CIT
Outreach Team provides
great satisfaction, but it
should remain voluntary—
it requires a certain kind
of officer who is internally
motivated.”
—Officer Forrest Kappler
CIT Officer, Akron (Ohio)
Police Department

Step by Step: The Program Design Process

9

more in keeping with community policing principles—in which officers are reviewed
for their problem-solving and de-escalation skills instead of the number of arrests they
make.
Question 2: What mental health system characteristics are relevant in

planning a specialized response to people with mental illnesses?
As part of the program design process, stakeholders should catalog available mental health
resources in the community, identify the criteria for or any restrictions to accessing them,
and describe their capacity and availability. For example, if there are no twenty-four-hour
facilities to receive people with mental illnesses except emergency rooms, and officers are
required to wait hours with the individual to be seen, alternatives can be explored. And
if facilities will only accept individuals who meet specific eligibility criteria, such as only
individuals not under the influence of drugs or alcohol, it becomes clear that other options
must be indentified to support officers when they encounter these individuals.
The planning group and relevant stakeholders should then identify service gaps.
Community mental health resources might include emergency departments, inpatient
and outpatient treatment programs, crisis response services, emergency receiving centers,
family support programs, telephone hotlines, clubhouses and other peer-to-peer supports,
and ancillary services such as housing assistance and income and entitlement support.20
Throughout this review, the planning group should work with policymakers and other key
groups to examine the structure of the mental health system and understand variations
in catchment areas (municipal vs. county) and revenue sources (private vs. public). These
variations may affect law enforcement responses by impacting where officers can transport a
person in crisis.
Beyond identifying available mental health resources, stakeholders should become
familiar with the avenues available to law enforcement officers to access these services
(whether in person, by telephone, or through a referral mechanism), understand the
requirements for medical clearance, and clarify existing protocols or procedures for
voluntary and involuntary admissions for mental health evaluations and assessments.
Question 3: What state laws are relevant in planning a specialized response to

people with mental illnesses?
State laws can address a range of issues relating to the law enforcement response. For
example, they can mandate law enforcement training and dictate the criteria that must be
met and the protocols that must be followed for an emergency mental health evaluation.
Local law enforcement officers can play a critical role in this process. In Nebraska, for

20. According to the International Association of Clubhouse Development, a clubhouse is “a community
intentionally organized to support individuals living with the effects of mental illness. Through
participation in a clubhouse people are given the opportunities to rejoin the worlds of friendships, family,
important work, employment, education, and to access the services and supports they may individually
need.” More information is available at www.iccd.org.

10

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

example, a sworn law enforcement officer is required to determine if a person meets the
criteria for involuntary emergency evaluation, to maintain custody of the person, and to
transport the person to the mental health receiving facility. In other states, a magistrate
or clinician might be required to make the commitment determination. States may have
outpatient commitment laws that can be enforced prior to consumers becoming dangerous
to themselves or others. Consumers may develop advance directives that provide instructions
for how they wish to be treated if they decompensate. These mandates and regulations
can present both an opportunity and a burden on law enforcement officers, and should be
considered fully by planners.
Question 4: What demographic and geographic community characteristics are

relevant in planning a specialized response to people with mental illnesses?
A jurisdiction’s population, population density, land area, and crime patterns can present
important constraints or benefits to developing specialized response programs. For example,
a jurisdiction whose only emergency mental health resources are located far from particular
law enforcement beats or districts will require officers to spend long periods out of service
transporting individuals, particularly if they have to pass through densely populated, trafficcongested areas. Rural and urban areas may have very different problems that will affect
dispatch and response times. Some rural areas may be dependent on only phone access to
mental health professionals who can direct emergency evaluations. Further, an area that is
populated primarily by seniors may have very different needs than those that are generally
young families with children, or that have a large number of homeless individuals. Although
jurisdictions of every size can struggle with inadequate resources (especially when budget
cuts directly impact state and community mental health services), these considerations
should be addressed carefully when shaping a law enforcement initiative.

Step 5:

Establish response protocols
At this stage of design, the planning group will understand how law enforcement, mental
health, and other community-based providers are currently responding to people with
mental illnesses who are at risk of criminal justice involvement. Based on the community’s
characteristics, it should be possible to see how these can be better integrated and shaped to
address identified problem areas and service gaps. Program development decisions at this
point in the process should focus on which law enforcement and mental health responses are
needed, both individually and collectively, and what resources are needed to support them.
Question 1: What law enforcement responses are necessary?
There are three main categories of law enforcement first-responder activities that require
consideration and planning—call-taker and dispatcher protocols; on-scene activities

Step by Step: The Program Design Process

11

(stabilization, observation, and disposition); and
transportation and custodial transfer.21 Planners
must decide which personnel will serve as primary
responders to scenes involving a person in a mental
health crisis, and how they will be dispatched. Based
on the review of the law enforcement/mental health
problems and community characteristics, they may
choose to train a subset of officers for this responsibility,
train all officers, or pair officers with mental health
clinicians or caseworkers. In addition to these activities,
planners may also choose to involve law enforcement
officers in follow-up activities not generated by a call for
service.

There are immeasurable
benefits to officers who
travel with mental health
professionals on the SMART
teams both for the officers
and the clinicians in terms
of information exchange and
awareness.”
—Commander Harlan Ward
Assistant Commanding Officer of
Valley Bureau, Los Angeles (Calif.)
Police Department

Question 2: What mental health system responses are necessary?
Mental health personnel may be involved in a variety of ways, including providing
information to dispatchers, co-responding to calls for service involving a person with mental
illness, acting as a remote resource if no on-scene professional can be available, helping to
train or cross-train personnel, and coordinating a follow-up effort, particularly with people

Essential
Elements

4–6

Essential Element 4—Call-Taker and Dispatcher
Protocols

Call takers and dispatchers identify critical information to direct calls
to the appropriate responders, inform the law enforcement response,
and record this information for analysis and as a reference for future calls
for service.

Essential Element 5—Stabilization, Observation, and
Disposition
Specialized law enforcement responders de-escalate and observe the nature of
incidents in which mental illness may be a factor using tactics focused on safety.
Drawing on their understanding and knowledge of relevant laws and available
resources, officers then determine the appropriate disposition.

Essential Element 6—Transportation and Custodial Transfer
Law enforcement responders transport and transfer custody of the person with
a mental illness in a safe and sensitive manner that supports the individual’s
efficient access to mental health services and the officers’ timely return to duty.

21. Each of these three categories represents one of the ten elements in The Essential Elements of a Specialized
Law Enforcement-Based Response. For more information, see http://consensusproject.org/jc_publications/
le-essentialelements.pdf.

12

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

identified as high utilizers of emergency mental health services.
Collaboration for certain activities may be best achieved through
co-location of law enforcement and mental health coordinators
or such mechanisms as merged or integrated databases that are
consistent with privacy laws.
As the Justice Center’s Essential Elements publication
indicates, individuals with mental illnesses often require an
array of services and supports, which can include medications,
counseling, substance abuse treatment, income supports and
government entitlements, housing, crisis services, peer supports,
case management, and inpatient treatment. Planners of the SPR
program should anticipate the treatment needs of the individuals
with whom law enforcement will come in contact and work with
service providers in the community to ensure these needs can be
met and coordinated.

We need to create drop-off
stations at the hospital to
receive people in crisis. This
requires not only trained law
enforcement staff, but also
an appropriate space—a
space where we can safely
manage the behavior of
people who are out of
control.”
—Marie Moon Painter
Clinical Team Leader for
CONNECT, Carilion St. Albans
Behavioral Health, Virginia

Because many individuals with mental illnesses who come into contact with law
enforcement have co-occurring substance use disorders, the availability of integrated
treatment approaches is essential to achieve clinical and public safety objectives.
Accordingly, stakeholders should consider how the program can help connect individuals
with co-occurring disorders to integrated treatment and should advocate for greater access
to this and other evidence-based practices.22 Histories of trauma and post-traumatic
stress disorder are common in criminal justice-involved populations. As such, both the
on-scene response of law enforcement and subsequent clinical responses must be traumainformed. Planners should pay special attention to the service needs of racial and ethnic
minorities and women by making culturally competent and gender-sensitive services
available to the extent possible.
Stakeholders should also identify ways to improve the efficiency of access to needed
services. This may entail broader system changes and agreements, such as streamlining
the custody transfer process at a mental health intake facility through memoranda of
agreement (MOAs) and revised protocols. Law enforcement should have within easy
reach twenty-four-hour drop-off facilities or emergency room(s) designated to expedite the
transfer of custody to ensure the individual receives swift mental health services and allow
officers to return quickly to duty.23

22. Evidence-based practices (EBPs) are mental health service interventions for which consistent scientific
evidence demonstrates their ability to improve consumer outcomes. R.E. Drake, H.H. Goldman, H.S. Leff,
A.F. Lehman, L. Dixon, K.T. Mueser, and W.C. Torrey, “Implementing Evidence-Based Practices in Routine Mental
Health Service Settings,” Psychiatric Services 52 (2001): 179–82. Other EBPs include assertive community
treatment, psychotropic medications, supported employment, family psychoeducation, and illness selfmanagement, see Fred C. Osher and Henry J. Steadman: “Adapting Evidence-Based Practices for Persons with
Mental Illness Involved with the Criminal Justice System,” Psychiatric Services 11 (2007), 1472–78.
23. For more information about the role of specialized crisis response sites, see Henry J. Steadman, Kristin A.
Stainbrook, Patricia Griffin, Jeffrey Draine, Randy Dupont, and Cathy Horey. “A Specialized Crisis Response Site
as a Core Element of Police-Based Diversion Programs,” Psychiatric Services 52 (2001): 219–22.

Step by Step: The Program Design Process

13

Question 3: What other responses or resources are necessary?
While law enforcement agencies and mental health professionals can provide the majority of
responses that the planners will prioritize, other partner organizations and their resources
may be required to address the problem faced by the community. For example, consumeror advocate-led organizations, such as clubhouses, can provide essential support to people
in crisis and supplement limited mental health resources. Non-law enforcement criminal
justice professionals, such as judges, magistrates, and jail personnel, can play an important
role in identifying and assessing individuals who may be in need of emergency mental health
evaluations.
The planning committee also should identify the availability of community and
government resources that focus on critical issues that disproportionately tend to affect
people with mental illnesses (such as housing, employment, education, substance abuse
treatment, and veterans’ services). An assessment of their accessibility in the community
should be part of the planning process.

spotlight

Systemwide Solutions

The 2002 landmark Consensus Project Report—written by Justice Center staff and representatives
of 100 leading criminal justice and mental health policymakers, practitioners, and advocates
from across the country—provides policy guidelines and practical recommendations for
improving the criminal justice system’s response to people with mental illnesses. The policy
statements and recommendations span the entire criminal justice continuum, from the law
enforcement encounter, through court involvement and incarceration, to the individual’s
reentry into the community. The success of recommended efforts is dependent on collaboration
and partnership among the full range of criminal justice agencies and their community
partners. It recognizes that law enforcement, courts, or corrections officials’ actions have
ramifications for the rest of the criminal justice system.
This interconnectedness highlights the value of creating a systemwide commitment to
change, in which reforms at each point of contact between the individual with mental illness
and a different criminal justice agency are woven together. There is a wide variety of program
models that focus on a different point of intercept in the criminal justice system, including the
following:
• Law enforcement specialized responses, which use specially trained law enforcement
officers to de-escalate incidents involving people with mental illnesses and divert them to
services when appropriate.
• Mental health courts, which are specialized dockets that link defendants with mental
illnesses to court-supervised, community-based treatment in lieu of traditional case
processing when warranted.
• Post-booking jail diversion programs, which screen and assess people with mental
illnesses in the jail, and divert them to community-based services when suitable.
• Specialized probation caseloads, which integrate community corrections supervision
strategies with community-based mental health treatment and services through a variety
of methods.
For more information on the Consensus Project report and the many program models, see
www.consensusproject.org.

14

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Step 6:

Determine training requirements
Once planners determine which types of responses are best suited to their local needs and
resources (such as a specially trained unit, co-responder model for a subset of officers, or all
officers who respond with special unit backup), the group can begin developing a training
curriculum and schedules. Both law enforcement and mental health agencies or providers
will have concerns about their ability to afford and prepare quality training, including how
to address such issues as compensation for trainers, continued education accreditation,
and covering shifts for officers in training or fitting it into already packed recruit training
schedules. These concerns need to be factored into decisions about how many and how often
first-responders are trained.
Question 1: How much training will be provided and to

which law enforcement personnel?
How much training is not only a question of hours spent in
the classroom, but also of the number of officers trained and of
how often training is held. Many agencies with specialized law
enforcement-based response programs require that 20 percent
of the department’s officers receive forty hours of training.24
However, there are other approaches that planners can consider,
including increased training on mental health issues for recruits
or ongoing education requirements for all officers. Dispatchers
and call takers will also require training on the program model,
to help them identify calls for service that may involve a person
with mental illness and then to dispatch the correct personnel to
the scene. They may also be able to ask questions that can help
officers who arrive at the scene, and to collect information about

Essential
Element

Some law enforcement
agencies only send officer
volunteers to attend the
training, while others
send all officers. There are
always some officers at the
training who don’t want
to be there. After a day or
two, though, even reluctant
officers understand that
this program is about officer
safety.”
—Patrick Halpern
Executive Director, Mental Health
Association of the New River
Valley, Inc., Virginia

Specialized Training

All law enforcement personnel who respond to incidents in which
an individual’s mental illness appears to be a factor receive training
to prepare for these encounters; those in specialized assignments
receive more comprehensive training. Dispatchers, call takers, and other
individuals in a support role receive training tailored to their needs.25

3

24. The CIT Center at the University of Memphis has released the “Crisis Intervention Team Core Elements”
(available at http://cit.memphis.edu/CoreElements.pdf), which outlines their suggestions for length of training
(forty hours) and the number of officers trained within an agency’s patrol division (20 to 25 percent). The guide
provides detailed information about the Memphis CIT Model.
25. To learn more, download Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement
Training from www.consensusproject.org/issue_areas/law-enforcement.

Step by Step: The Program Design Process

15

the disposition of calls involving people with mental
illnesses to help administrators determine the number
and effectiveness of specialized responses.
Question 2: What topics should training cover?
Training curricula should be geared toward the
particular law enforcement personnel (line-level,
special teams, dispatchers) and include information
specific to the jurisdiction (for example, state
commitment laws and local resources). Although
there is no single curriculum that will address the
needs of all jurisdictions, several training topics form
the foundation of a comprehensive training program.
These include understanding mental illness, statutory
authorities governing law enforcement responses,
the law enforcement response to calls for service,
community policing/problem solving, and use of
force.26 The training is not intended to turn law
enforcement officers into diagnosticians, but rather
to train them to look for behaviors associated with
mental illnesses and determine the best way to address
those behaviors. Specific skills training may include
a combination of verbal de-escalation techniques and
suicide prevention methods.

Because of the limitations
posed by our jurisdiction’s
size, in addition to forty
hours of training for officers
on our special teams, we
decided to provide twentyfour hours of online training
to all of our officers on
mental health de-escalation
techniques.”
—Commander Harlan Ward
Assistant Commanding Officer of
Valley Bureau, Los Angeles (Calif.)
Police Department

It is important to provide
training to all officers on
encounters with people
with mental illnesses, and
e-learning has an important
place in the picture.”
—Mark Gale
Member, Board of Directors,
NAMI–California

Question 3: Who will provide the training?
Training for law enforcement officers on effective responses to people with mental illnesses
must draw on a diverse range of expertise and perspectives to cover a broad range of topics,
from recognizing signs of mental illness to understanding the state’s emergency evaluation
laws. Many of these topics may be better taught by experts from disciplines other than law
enforcement. For example, signs of mental illnesses may be taught by a psychiatrist or
mental health clinician, whereas de-escalation techniques may be best taught by a seasoned
law enforcement officer who can provide real-life examples. Consumers and family members
can provide a face and a voice for people struggling with mental illnesses, and they are
uniquely qualified to promote a compassionate response from officers who often see people
with mental illnesses only when these individuals are in crisis. Training coordinators might
not know who would be a good fit to teach all modules, so it is important that coordinators
reach out to community partners to collaborate on identifying trainers or facilitators.27

26. This list is drawn from Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement
Training, “Appendix B: Suggested Training Topics,” page 41.
27. For more information on how to identify trainers, see “Chapter 1: Identifying Trainers” on page 8 of Improving
Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement Training.

16

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Question 4: What training strategies will be employed?
Effective training strategies are critical to a specialized law
enforcement-based program. These strategies may include
short lectures that focus on behaviors and plain language
rather than diagnoses and medical terms; site visits to some
of the mental health facilities where they will do custodial
transfers or refer individuals for treatment or support;
role plays to engage officers in real-life interactions that
can be acted out and corrected in a safe environment; and
question-and-answer sessions to prompt officers to consider
and discuss their own experiences, preconceptions, and
concerns. Traditional classroom-style training is invaluable,
but as a supplement, many agencies have started to develop
e-learning platforms to engage personnel who work
nontraditional hours and to increase access to specialized
training topics.28

We trimmed the forty-hour
training curriculum by
determining what course
content the officers really
needed. We had a four and
one-half-hour block on
psychopharmacology, and
while it is important to
understand what these drugs
are, the reason the police
officer is there is because
the person is NOT taking
their medications. We now
tell officers what these
medications are, what they
do, and give them a card to
refer to.”
—Dr. Luann Pannell
Director of Police Training and
Education, Los Angeles (Calif.)
Police Department

Step 7:

Prepare for program evaluation
It is not enough to simply identify what information will be collected (as outlined in Step 3)
to ensure effective evaluations will be conducted. It is important for planners to prepare for
a program evaluation as part of the design process. As previously mentioned, the program
evaluation should contain both a process assessment as well as an assessment of outcomes.
This evaluation will be needed to make revisions to the activities that may be experiencing
difficulties and to enhance those that are effective, as well as to provide proof of the program’s
success to foster sustainability.
Question 1: What resources need to be set aside or identified for an evaluation?
A thorough program evaluation will require the allocation of resources to analyze the data
collected. Agencies with planning and research divisions may want to identify department
staff and allocate a percent of their time during the program design phase to coordinate or
conduct these evaluations. Agencies without research capacity may benefit from outside
assistance in aggregating, deciphering, and interpreting the data to determine program
effectiveness. Because of the challenges associated with data collection, as well as the
difficulties in analyzing often incomplete data, many law enforcement agencies partner
with a local college or university to assist with this process. Academic partners may require
compensation for which law enforcement agencies may need to find sources of support,

28. For more information on training strategies, see “Chapter 2: Effective Training Techniques” on page 22 of
Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement Training.

Step by Step: The Program Design Process

17

including submitting joint grant proposals. If the department chooses to engage an external
research partner, these outside teams will need to work closely with law enforcement and
their collaborators during the evaluation process, and this staff time commitment should be
considered at the planning stage.
Question 2: Are there individuals designated to oversee the evaluation?
Law enforcement agencies should designate a staff person who will work with a
subcommittee on evaluation issues. In addition to helping to ensure that all agencies that are
contributing data are using sound and accurate collection and reporting practices, this group
can determine how the evaluation results will be used, how they will be disseminated, and
who should be brought to the table during the evaluation process to review interim reports
and the interpretations of the data.

Conclusion
The seven steps to program design summarized in this section may seem straightforward.
They are not. Law enforcement agencies and their community partners are struggling to
navigate the many issues that are involved in making the proper decisions at each stage in the
process. And as new information is made available, it is necessary to revisit previous steps.
To fully grasp the challenges in following these design steps, policymakers and planners
interested in exploring a specialized policing response to people with mental illnesses must
operate within a framework defined by two complex forces—the nature of the problem and
the jurisdiction’s distinct characteristics.
Though the problem frequently relates to safety concerns and strains on police resources
that do not result in good outcomes for law enforcement, the individual, or the community,
jurisdictions may find that data and discussions lead them to other issues or sub-issues
that need particular attention. Crafting the solutions to these problems—including changes
to law enforcement training, policies, and procedures—cannot be shaped in a vacuum.
Training officers on diversion and other strategies, for example, will be ineffective if mental
health resources in the community are not available or lack the capacity to support increased
referrals and placements. Accordingly, jurisdictions will be limited by the resources they have
or believe they can create or expand.
The following section explores how various problems and community characteristics have
shaped responses in the agencies studied and how other jurisdictions might expect these
factors to influence their own program design and enhancements.

18

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Section II
From the Field:
Program Design in Action
This section provides practical advice on how to consider
common problems as experienced by the four sites
studied. It also considers various law enforcement, mental
health, and other community characteristics, and their
relative impact on program design. Examples from the
field are included to illustrate how these problems and
characteristics are reflected in program implementation.

Tailoring Specialized Policing
Response Programs to Specific
Problems29
The three most commonly encountered problems found
in the four communities studied were unsafe encounters,
frequent arrests of people with mental illnesses and
the strains on law enforcement resources, and high
utilization of emergency services. It is important to note
that this separation of problems into distinct categories
is somewhat artificial, as they often overlap and relate
to one another. Other communities may find their data
lead them to identify different problems beyond these
three types. The chart that follows provides an overview
of how the four sites tailored their responses to their
community’s problems.

If you want it to be collaborative,
you need to be flexible and
adapt this program to your local
community.”
—Sgt. Michael Yohe
CIT Coordinator, Akron (Ohio)
Police Department

CIT is a godsend. The community
of people with mental illnesses
was getting badly treated and CIT
has been an undisputed success.
There are very few situations
where the response is poor.”
—Tom
Consumer, Carriage House
(Fort Wayne, Ind.)

It may well take a tragedy to
mobilize the resources….”
—Assistant Chief
Jim McDonnell
1st Assistant Chief, Chief of Staff, Los
Angeles (Calif.) Police Department

I feel that CIT changed our understanding of what the police
officers are capable of doing with de-escalation and compassion.”
—Jim Randall
President, NAMI–San Fernando Valley (Calif.)

29. Cordner’s guide, “People with Mental Illness,” outlines a variety of response strategies that decision-makers
can consider when choosing how to best respond to the problem they are facing in their local community. These
response strategies are also summarized in a table that presents the response type, how it works, when it works,
and additional considerations to take into account.

From the Field: Program Design in Action

19

The Impact of Problem Type on SPR Programs30
Problem Type

Jurisdictions

SPR Program Activities

Unsafe Encounters

Los Angeles, Calif.
Akron, Ohio
Fort Wayne, Ind.
New River Valley, Va.

Officers trained on mental health issues respond
to the scene when dispatched. (In the LAPD,
a call can also be triaged to dispatch a special
co-response unit. See box below.)
Related issues are addressed during training for
officers on mental health topics.
Training is provided for dispatchers.

Frequent Arrests
and Strains on
Police Resources

Los Angeles, Calif.

Co-responder teams are dispatched to the scene
when requested by a first-responder.
Crisis mental health clinicians also respond to the
scene.
Additional dispatch capability is used to “triage”
incidents requiring the co-response team.

Akron, Ohio
Fort Wayne, Ind.
New River Valley, Va.

Related issues are addressed within the forty
hours of training for officers.
Emergency psychiatric facilities streamline intake
procedures for law enforcement.

High Utilization
of Emergency
Resources

Los Angeles, Calif.
Akron, Ohio

Follow-up teams of law enforcement personnel
and mental health clinicians work on case
management for referred cases, including
cases brought to their attention by involved
stakeholders.

Relatives of consumers are now less reluctant to involve the police because
family members realize that a compassionate officer will respond to the
call. Consequently, families do not wait until the situation has escalated,
and officers now respond to less threatening calls. This allows them
to intervene at an earlier point. No CIT officer has been injured when
responding to a person with mental illness.”
—Lieutenant Mike Woody (ret.)
Law Enforcement Liaison, Ohio Criminal Justice Coordinating Center of Excellence

30. Many of the “SPR Program Activities” listed here address more than one problem. In practice, these responses
often straddle the goals of improving safety, reducing frequent calls for service, and decreasing the use of
emergency resources.

20

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Problem: Unsafe outcomes of encounters between

law enforcement and people with mental illnesses
When communities experience a tragedy related to a
law enforcement encounter involving a person with
mental illness, there is often a flurry of activity to
determine what factors contributed to that outcome and
to ensure it will not happen again. Several factors seem
to affect safety at the scene. Many community members
interviewed for this project noted that when consumers
have had previous negative encounters with law
enforcement, they become fearful and distrusting during
subsequent interactions. A person’s fear can then be
exacerbated by the officer’s uniform and an authoritarian
approach. Even individuals in crisis with no previous
contact with officers may have extreme reactions to being
crowded or subjected to officers’ commands.
Community members interviewed also recognized
that traditionally trained law enforcement officers often
lack information about mental illnesses, particularly
information about strategies to calm crisis behavior
and avoid use of force. Without adequate training,
officers may also be fearful of individuals with mental
illness and may misperceive them as more dangerous,
affecting officer posturing and reactions. It is important
to recognize that much of an officers’ academy training
is oriented toward taking control of a situation and
resolving it as quickly as possible—which may run
counter to specialized response strategies. These factors,
together with dynamics such as the level of access
to mental health supports, guidelines on less-lethal
weaponry and tactics, and whether the individual is
taking medications or is abusing drugs or alcohol, can
all contribute to concerns about the safety of all those
involved in these encounters.

Tailored Responses
Based on the sites visited and related project research,
programs designed to respond to safety concerns during
these encounters were found to be aimed primarily at
officer education and quick, on-scene de-escalation of
crisis behavior. Other responses include the training
on and use of less-lethal weapons, helping call takers
and dispatchers get the best possible information to the

One of the largest complaints by
NAMI and other advocates was
the lack of understanding by the
officers of how to communicate
with people with mental
illnesses.”
—Commander Harlan Ward
Assistant Commanding Officer of
Valley Bureau, Los Angeles (Calif.)
Police Department

There are times when the police
must run from call to call. But
there will come a time when
an officer’s compassion will be
necessary to resolve a situation,
and the officer will need to step up
and come through.”
—Bernie
Mental Health Consumer (Akron, Ohio)

Injury on the job could lead to job
loss—therefore, any opportunity
to learn additional officer safety
techniques is a plus.”
—Officer Lori Natko
CIT Officer, Akron (Ohio)
Police Department

CIT provides the opportunity to
really sit and listen more than
talk. Usually we just tell people
what we are going to do. I plan
to try to volunteer for as long as I
can—I see different things all the
time.”
—Officer Mark Bieker
CIT Officer, Fort Wayne (Ind.)
Police Department

From the Field: Program Design in Action

21

Akron Tailors Response to Safety Concerns and Repeat
Calls for Law Enforcement and Mental Health Services*
Quick Facts
Government type: Municipal
Jurisdiction type: Urban
Population in 2007: 207,934 (estimate)
Area of Akron in square miles: 62.4

Number of sworn personnel in 2006: 451
Number of civilian personnel in 2006: 43
Program name: Crisis Intervention Team (CIT)
Program start date: 2000

Overview
The Akron (Ohio) Crisis Intervention Team (CIT) was one of the first agencies to replicate the
Memphis CIT Model. Although this community maintains fidelity to the model, they have made
several adjustments to the core elements. For example, CIT Officers in Akron have access to four
emergency resources, rather than the single point of entry available in Memphis. This adaptation
was made to ease the burden on any single mental health facility. Akron has also modified the
CIT training to include a segment about being a CIT officer, including safety issues, duties, and
officers’ experiences.

Tailored Responses
Once CIT was implemented, Akron stakeholders determined the need for a supplemental
program to address the needs of their “at-risk” population—those individuals who are repeat
clients of both the criminal justice and mental health systems and who often fall through the
systems’ cracks. The “CIT Outreach Program” consists of a group of officers who team up with an
outreach worker from Community Support Services (CSS). Officers in uniform ride together with
a CSS worker in a marked cruiser to contact referrals and attempt to engage people in services.
Akron reported that pairing a law enforcement officer with a case worker to conduct followup can also facilitate information sharing, locating individuals, and increasing the safety of
encounters.
Outreach teams can refer individuals to mental health and other services, such as elder care
and drug addiction services. When the team encounters someone who does not qualify for an
involuntary commitment order, they are often able to persuade the person to voluntarily go to
CSS, where they are welcomed in the back door with dignity and discretion.

Unique Program Features
The CIT program coordinator in Akron maintains his patrol duties, which lends credibility to
the program and assists in soliciting officer involvement. When the outreach team transports
an individual in a marked cruiser, he or she rides without handcuffs in the back seat with
the mental health case manager. The person may meet criteria for emergency mental health
evaluation, but the officer allows the person to ride without handcuffs when the situation is
under control. If the person is at risk of harming him- or herself or others, or attempts to leave,
the police will then use handcuffs and transport as needed.

* Dates and figures in this sidebar are consistent with the most recent information available at the time of
this writing.

22

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Fort Wayne Tailors Response to Safety Concerns and
Problems in Schools*
Quick Facts
Government type: Municipal
Jurisdiction type: Urban
Population in 2007: 251,247 (estimate)
Area of Fort Wayne in square miles: 79.12

Number of sworn personnel 2006: 435
Number of civilian personnel 2006: 100
Program name: Crisis Intervention Team (CIT)
Program start date: 2001

Overview
Fort Wayne (Ind.) operates a traditional CIT program. Law enforcement plays a primary role in
the program, but it is also shaped by mental health consumers, available resources, and a strong
NAMI presence. Fort Wayne made several adjustments to the traditional CIT model. CIT officers
in Fort Wayne have access to two hospitals and a transitional care center, where Memphis has
only a single point of entry to mental health emergency services. This change broadens the range
of services available to CIT officers, and the hospital and transitional care center staffs assist in
transporting consumers to the hospital where they may have received services in the past. Fort
Wayne also added training topics on problems of concern that were not required in the Memphis
curriculum, such as a unit on autism.

Tailored Responses
After implementation of the CIT program, Fort Wayne identified several problem behaviors
among middle and high school students. In some cases, self-mutilating behavior was detected,
and in other cases, schools were struggling to manage the behavior of “bad kids.” Their only
options at that time were to expel these students or have police arrest them for such acts as
vandalism.
To address these school problems, CIT program planners began providing CIT training to all
of the School Resource Officers (SROs). In addition, a CIT-trained officer has helped identify high
school students who might benefit from mental health services. This officer’s training enabled
him to recognize that some students were not simply acting out, but may have serious mental
health problems. On more than one occasion, this officer used his training to gain a student’s
trust, so the student could talk openly about what was happening in his or her life and get help.

Unique Program Features
Fort Wayne is fortunate to have the extensive involvement of a judge who reviews all civil
commitment hearings and participates in officer training. Their program also uses a “stat sheet”
to collect information on the number of calls the police get, how many are diverted at the scene,
how many are brought to the hospital for twenty-four-hour observation, and how many are kept
for seventy-two-hour holds. The form also collects data on the presence of weapons and whether
the case involved a suicide attempt. This stat sheet then follows the consumer through the
mental health system. If he or she is brought to the emergency room and a need for detention is
identified, the stat sheet becomes the “face sheet” for the seventy-two-hour hold and is faxed to
the judge for review. All face sheets are retained in the police department’s records, are analyzed
on a monthly basis to track program responses, and are reviewed by the Judge and CIT Sergeant
for accuracy. Summary data are shared appropriately to keep all stakeholders routinely informed
about program progress.

* Dates and figures in this sidebar are consistent with the most recent information available at the time of
this writing.

From the Field: Program Design in Action

23

officers suited to address the situation, developing means
for capturing information that will improve safety for
repeat calls for service, and involving a secondary mental
health response.
Programs that respond to safety concerns emphasize
specialized training on policies and practices designed
to help law enforcement officers take adequate time
and steps to identify the signs and symptoms of mental
illnesses. These programs reflect the understanding that
these behaviors may be the result of an illness, draw
on effective communication and behavioral strategies,
and familiarize officers with less-lethal force options.
Training includes the opportunity for role-play scenarios
that enable officers to practice and hone their skills in
addressing “real-world” crises before applying them
in the field. These skills include those involved in
maintaining the safety of all involved and determining
whether the person meets the criteria for emergency
mental health evaluation. Specially trained law
enforcement officers apply their new skills in the field
to determine if the situation involves a person who may
have a mental illness. If it does, officers are trained to deescalate the person’s behavior and to connect him or her
to treatment when appropriate. When safety concerns
involve educational institutions, additional personnel
may receive specialized training. In Fort Wayne, for
example, the department requires that all school resource
officers (SROs) attend CIT training.
Specialized training for call takers and dispatchers
is critical to officer and consumer safety. This training
provides tools for call takers to identify calls that may
involve a person with a mental illness, gather important
information about the situation from the caller (for
example, when possible, the person’s previous reactions
to law enforcement, the person’s medication status,
any history of violence) and provide that information to
responding officers. Dispatchers follow specific protocols
to help ensure that specially trained officers respond
quickly to incidents they believe may involve a person
with a mental illness.
Call takers clear calls and make notations in the CAD
system about the involvement of weapons or violence
to enhance safety should this location draw future
calls for service. For example, in Akron, dispatchers

24

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

The police response
has become seamless
and is totally accepted.
Consumers even call police
themselves now, which
would not have happened
prior to CIT.”
— Jane Novak
Member, NAMI-Indiana

Our dispatchers are trained
in verbal de-escalation
and can sometimes avoid
dispatching the police by
talking down the individual
on the phone.”
—Lorie Witchey
Dispatcher, Akron (Ohio)
Police Department

I was a practicing public
defender for ten years and
saw how many clients had
real issues with mental
health and co-occurring
substance use disorders. I
knew these people would
benefit from treatment and
should not be in jail. Once
they were in jail, they got
stuck there.”
—Victoria Cochran
Chair, State Mental Health,
Mental Retardation and
Substance Abuse Services Board

Don’t let anyone tell you we
did not have a problem with
arresting people who were
mentally ill. Our people
didn’t realize they had a
mental illness and we were
putting them in jail when
they were sick.”
—Officer Danny Ratcliffe
CIT Officer, Pearisburg (Va.)
Police Department (NRV)

review incident reports and flag locations relating to a
person with mental illness, focusing on the presence
of a weapon or specific strategies that may have proven
successful in de-escalating an encounter with the subject
of the call for service. This information can be used to
improve the dispatching and response of officers for any
future calls to that location.

People were going to jail when
they should not have. If you
are mentally ill, jail is not the
solution.”
—Amy Tyler
Director of Behavioral Health,
St. Joseph Hospital (Fort Wayne, Ind.)

When tailoring a response program to safety
concerns, the interviewed sites only included onscene mental health experts as a secondary response.
For example, in the agencies studied, a mental health
professional might come to the scene, but only after the

New River Valley Tailors Response to Safety Concerns in
Rural and Small Communities*
Quick Facts†
Government type: County, Municipal
Jurisdiction type: Rural, multi-jurisdictional
Population in 2007: 172,255 (estimate)
Area of New River Valley in square miles:
1,469 (estimate)

Program name: New River Valley Crisis
Intervention Team
Program start date: 2002

Overview
In response to growing concerns about the number of people with mental illnesses in the
criminal justice system, program planners in New River Valley, Va., developed a multijurisdictional CIT that involves fourteen different law enforcement agencies within four counties
and one city in a largely rural area. These agencies have found it difficult to implement state
mandates that people with mental illnesses who qualify for emergency assessment must remain
in the custody of law enforcement officers until an emergency service clinician can complete
the assessment, and if necessary arrange for mental health services. Prior to the site visit, law
enforcement custody could last up to four hours and individuals could not be placed in jail.
(Legislation in 2008 increased the mandatory custody up to six hours to provide sufficient time
for the provision of medical clearance.) Mental health resources are limited and the rural nature
of the community requires emergency service clinicians and law enforcement officers to travel
long distances to conduct assessments and then transport individuals to available inpatient
facilities. The Mental Health Association (MHA) in Blacksburg, Va., funds a CIT coordinator,
whose responsibilities include arranging for CIT training.
continued on next page
* Dates and figures in this sidebar are consistent with the most recent information available at the time of
this writing.
† Population and area figures of the New River Valley are aggregate numbers for the jurisdictions that make
up the “valley:” Montgomery County, Pulaski County, Floyd County, Giles County, and the independent City of
Radford. Given the multi-jurisdictional structure of the region, data were not available on the number of law
enforcement personnel.

From the Field: Program Design in Action

25

New River Valley continued

Tailored Responses
The New River Valley CIT brought together fourteen jurisdictions that all fell within one of
Virginia’s mental health catchment areas. The goal of bringing the smaller, rural communities
together was to capitalize on shared resources. For example, agencies created agreements to
allow officers to cross jurisdictions and serve each other’s residents, and developed a plan to
provide CIT training to approximately 25 percent of the total number of patrol officers from the
combined forces to have sufficient coverage of shifts and locations.
To address the burdens placed on law enforcement and emergency service clinicians who
must travel long distances and spend hours maintaining custody of people who are in crisis,
program planners also intend to streamline procedures so that law enforcement officers can
take a person in crisis to a mental health facility and transfer custody to another designated
law enforcement officer stationed at the hospital. The hospital would then arrange for
appropriate assessment and placement if needed.

Unique Program Features
Stakeholders in the New River Valley note the profound impact the Virginia Tech shooting
in April 2007 had on mental health resources, particularly on inpatient hospitalizations.
According to the director of the New River Valley Community Services, there was a 99 percent
increase in hospitalization rates for children and youth after the shooting incident. Another
significant outcome of this tragic event was the enactment of new legislation that increased—
from four to six hours—the amount of time a person in mental health crisis could be detained.
To offset the demand this placed on law enforcement, the new legislation also allows “trained
security officers” to accept people who have an emergency custody order and to do paperwork
for emergency custody orders.
Due to differences in staffing and leadership styles, the participating law enforcement
agencies vary in their perspectives about how many—and which—officers in their agencies
should get CIT training. Consequently, the MHA trains some officers who do not volunteer
for the assignment and trains all officers from some of the agencies. The MHA director notes
that although some participants appear reluctant at the outset of training, two strategies
tend to transform them. First, even people who don’t want to participate in the CIT program
have a very different attitude about mental health consumers once they have been to the site
visits, where they meet with people who have mental illnesses who are doing well. Second,
information that stresses the impact of the CIT approach on officer safety can change the
minds of trainees who are otherwise disinclined to support a SPR.

The biggest problem with small departments is if we get taken
on a call where the person needs placement in a hospital, the
officer will be off-road for a whole shift. Oftentimes, we may
only have a total of two or three officers on a shift.”
—Officer Danny Ratcliffe
CIT Officer, Pearisburg (Va.) Police Department (NRV)

26

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

person’s behavior is stable and the officer is in control of
the situation. Typically in these response models, officers
will transport the person to a mental health facility where
mental health experts can conduct further assessment
if needed. Individuals interviewed in the studied sites
underscored that it is essential that these facilities allow
law enforcement officers efficient access to a wide range
of services.

Law enforcement officers felt
isolated from other service
providers before CIT, and their
knowledge of available resources
was limited.”
—Sgt. Michael Yohe
CIT Coordinator, Akron (Ohio)
Police Department

Problem: Frequent arrests of people with mental

illnesses and strains on police resources
Officers typically have three options when they encounter
someone with a mental illness whose behavior is
erratic—they can arrest the person if there is evidence
a crime was committed, transport the person to a
mental health facility in accordance with applicable
legal mandates, or stabilize the situation and leave the
person at the scene. Community members in each of
the four sites identified several problems related to the
limited options available for officers when encountering
people with mental illnesses. Some stakeholders believed
officers arrested people with mental illness who had
committed minor offenses much too frequently. In most
of these cases, individuals reported that the person’s
behavior may have been too disruptive for the officer to
leave him or her alone at the scene, and the officer did
not have adequate information about—or efficient access
to—available mental health resources.
In other communities, stakeholders noted problems
that occur when an officer must either remain with the
person in crisis until a mental health professional arrives
to conduct an assessment or transport the person to
an emergency room, where they may spend additional
hours waiting for the assessment to take place.

Before CIT, officers were
frustrated they had to wait a long
time before transferring custody.
With CIT, they could drop their
paperwork off and scoot.”
—Amy Tyler
Director of Behavioral Health, St.
Joseph Hospital (Fort Wayne, Ind.)

Our CIT program has diverted a
fair number of people from jail to
the mental health system, which
is improving the balance between
the legal system and the mental
health systems.”
—Deb Richey
Nursing Director of Emergency
Services, Parkview Hospital
(Fort Wayne, Ind.)

Tailored Responses
Programs developed in response to inefficient access
to mental health resources use strategies to make these
facilities more “officer-friendly.” In Fort Wayne, for
example, the receiving facilities’ administrators adapted
their procedures to prioritize intake for consumers
who officers bring to the facility, allowing the officers
to complete paperwork quickly and return to other

Since CIT was implemented,
fewer people are going to jail.
The contacts are better and
there are fewer arrests.”
—Andy Wilson
Executive Director, Carriage House
(Fort Wayne, Ind.)

From the Field: Program Design in Action

27

duties. In addition to minimizing the strain on law
enforcement time and resources, these efficiencies
can decrease the number of people who may
otherwise be taken to jail for minor offenses. When
coupled with officer training on local mental health
resources and de-escalating behaviors that might
otherwise result in more serious charges against the
individual, these changes can improve outcomes
for the person with mental illness and the law
enforcement first-responders.
Law enforcement responses that address poor
knowledge about and limited access to mental health
resources can also pair a law enforcement officer and
mental health service provider to respond together
to calls involving someone with a mental illness. In
most cases, co-responder teams are dispatched as a
“secondary” response. For example, in Los Angeles,
patrol units are dispatched to calls based on priority, as
is the usual practice.31 Once the patrol officer gets to
the scene, he or she will make a determination about
whether mental illness may be a factor and if the
co-response team is needed. When the co-responder
team arrives, the initial responding patrol officer
manages safety concerns. The co-response team—
both the law enforcement officer and the mental
health clinician—focuses on the person with mental
illness, making decisions about an assessment,
referral for service, and placement.32
In Los Angeles, an additional layer of dispatch
is in place to facilitate this model. Law enforcement
first-responders can ask patrol dispatchers for a
Systemwide Mental Assessment Response Team
(SMART); the dispatchers then route their call to the
“Triage Center” of the Mental Evaluation Unit (MEU),
where an officer assesses when to send out teams.
This triage officer can access the MEU database to
gather information on the criminal justice history
for the subject of the call for service. The forensic
nurse, who is co-located in this unit, can access the
Department of Mental Health (DMH) records. Both

It is the chief’s responsibility
to balance resources, which
involves practice, vision, and
creativity. There is a resource
benefit to the co-responder
model: pairing a civilian with a
sworn officer frees up other twoofficer cars.”
—Chief William Bratton
Los Angeles (Calif.) Police Department

Officers in [the CIT] program
come to recognize the
weaknesses in the mental health
system and how to navigate
them to benefit the consumer.”
—Ron Rett
Member, NAMI-Ohio

Through the partnership, police
officers often learn to mirror
the techniques that the mental
health practitioners use in
handling situations with people
with mental illnesses.”
—Dr. Tony Beliz
Deputy Director, Emergency
Outreach Bureau, Department of
Mental Health, Los Angeles County
(Calif.)

Patrol commanders and those
who respond to critical incidents
are learning that mental health
components are regularly
an issue, and therefore, they
recognize the value of MEU on
these scenes.”
—Lt. Michael Albanese (ret.)
SWAT Commander, Los Angeles
(Calif.) Police Department

31. When a call for service involves a person or place that has generated a high volume of previous police
responses, the dispatch system flags any mental health issues and the dispatcher shares that information with
the responding officers.
32. The Los Angeles County Department of Mental Health not only coordinates response teams with the Los
Angeles Police Department, but also with agencies in Long Beach and Pasadena.

28

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

sources of information can guide the triage and ensure
the responding team will have a more comprehensive
history on the individual. When SMART is dispatched,
the first-responder officers stay at the scene until the
person in crisis has been stabilized. This provides
support and backup to the SMART officer and the
mental health clinician.
Even in agencies where there is no co-location of
law enforcement and mental health personnel, coresponder teams can improve linkages to mental health
or substance abuse treatment. Because the mental
health professional has access to the person’s mental
health history, the team may be able to reconnect the
person to a clinician who has previously treated him or
her. In addition, mental health professionals working
with law enforcement are knowledgeable about a wider
range of services and supports, so they can find the
most suitable mental health approach to the individual’s
needs. According to those interviewed for the project,
co-responder teams can also assist in transportation to
a mental health facility for a greater range of situations
than law enforcement could alone. For example, the
team may have more time to transport people who
meet the criteria for involuntary evaluation to the
mental health facility, which frees the first responding
officer to return to patrol. In addition, because of the
involvement of a mental health professional at the scene,
co-responder teams may be able to transport people
voluntarily to services and supports that would otherwise
rely on a family member or public transportation.
Problem: High utilization of emergency resources
Many communities experience a large number of law
enforcement calls to the same locations, involving the
same people with mental illnesses without positive
effect. Many of these same individuals have been found
to also repeatedly need emergency medical services. This
small group of consumers, often referred to as “high
utilizers” of emergency services, typically represents
people who are difficult to keep connected with
nonemergency services, including continuous treatment
that is effective in relieving their symptoms. In some
cases, these individuals have co-occurring substance
use disorders, are homeless, or both. They may cycle in

Law enforcement leadership must
know how to apply the necessary
resources to solving crimes [and
disorder]. The best way to apply
limited resources is to focus on
the 10 percent of the population
that uses the greatest amount of
resources.”
—Chief William Bratton
Los Angeles (Calif.) Police Department

One challenging population is
[the group of individuals] who are
drug- or alcohol-dependent. They
are only at our hospital for a short
period of time and a large group
does not follow through with
treatment recommendations.
This can result in a revolving
door. The officer goes to the scene,
brings the person in, we end up
admitting them, and discharge
them two to three days later.
When they do not follow through
with treatment, they will be
back.”
—Patsy Hendricks
Director of Clinical Services, Parkview
Behavioral Health (Fort Wayne, Ind.)

I believe it is in part because of our
CAMP program that L.A. hasn’t
had [a mass shooting incident].
Once we identify someone who
has mental illness [that puts
them at risk of criminal justice
involvement] and put them in
the CAMP program, we monitor
them to make sure they get
medications, have housing, go
to work, and can take care of
themselves.”
—Captain Ann Young
Commanding Officer, Detective
Support and Vice Division, Los Angeles
(Calif.) Police Department

From the Field: Program Design in Action

29

Los Angeles Tailors Response to Safety Concerns and
High Utilization of Emergency Services*
Quick Facts
Government type: Municipal
Jurisdiction type: Urban
Population in 2007: 3,834,340 (estimate)
Area of City of Los Angeles in square miles:
498.3
Number of sworn personnel: 9,883
Number of civilian personnel: 3,263

Program names: Systemwide Mental
Assessment Response Teams (SMART) and
Case Assessment Management Program
(CAMP)
Program start dates: 1993 and 2005,
respectively

Overview
Los Angeles has implemented several complementary program responses to address the complex
needs of the jurisdiction. Los Angeles was one of the first communities to develop the police/
mental health co-responder teams (SMART) in 1993. This program was designed to better link
people with mental illnesses with appropriate mental health services. When the department
came under a U.S. Department of Justice consent decree in 2001, one provision directed the
agency to improve safety for all involved in officer encounters with people with mental illnesses.
At that time, the department also began implementing a CIT program in pilot locations.
However, due to its sheer size, both in area and in population, training the recommended 20
percent of its officers in CIT protocols could not effectively cover rapid responses. As a result,
department leaders chose to prioritize CIT training for officers most likely to come in contact
with people in a mental health crisis, although the training is not limited to these officers.

Tailored Responses
After implementation of CIT training and the SMART teams, a serious problem remained. A
group of people with mental illnesses who called the police repeatedly, or were the subject
of many calls for service, were costing the city millions of dollars in emergency resources.
Further, a large percentage of SWAT call-outs involved someone with a mental illness. The police
department developed the Case Assessment and Management Program (CAMP) to identify and
track the subjects of these repeat calls, and construct customized responses to their problems.
The program co-locates a police detective with psychologists and social workers from the
county mental health agency in the police department facility. This team develops long-term
solutions to an individual’s needs on a case-by-case basis. In particularly complex situations,
team members have conducted home visits on a daily basis, linked a person to service provision
in his or her home, provided transportation assistance, or made appointments for services or
treatment. The team members focus on developing trusting relationships with people in need
and few resist the help.
The CAMP program receives referrals from both SMART officers and mental health
professionals. When CAMP receives a referral, the psychologist reviews the information,
accesses the Department of Mental Health (DMH) records, and reviews the person’s history with
the police. The psychologist makes the determination about whether the person qualifies for
CAMP. For example, someone may qualify if incidents with the police have been high profile, if
the person is accessing more than three emergency resources, or the person has a large number
continued on next page
* Dates and figures in this sidebar are consistent with the most recent information available at the time of
this writing.

30

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Los Angeles continued
of calls to the police over a short period. CAMP cases are worked by the psychologist, a detective,
and a police officer. At this initial stage (level 1) the team develops and implements a plan for
mental health treatment and strategies for managing services. When the person stabilizes (level
2), the case shifts to periodic monitoring. For example, the detective may contact some clients
every week to check in, or stop by once a month. If the person remains stable and the family does
not need help, the case becomes inactive (level 3) and is filed.

Unique Program Features
The department formed the “Mental Evaluation Unit (MEU)” to oversee all of these programs
and manage points of intersection. The MEU contains a triage unit that fields calls from patrol
officers who have questions about what to do in certain situations involving people with
mental illnesses. In these circumstances, the triage officer consults the MEU database (separate
from the CAD system and protected from access outside the unit) to learn this person’s history
with the police. A triage mental health nurse sits alongside this officer and can check the DMH
databases to determine the person’s case manager, psychiatrist, or treatment centers. The triage
staff determines together whether to send out a SMART team or have the officer take the person
directly to a mental health facility. If the triage unit determines that this person has repeatedly
contacted police (or been the subject of frequent calls for intervention), they will refer the person
to the CAMP coordinator for follow-up.

and out of treatment, and many do not follow through
with treatment plans independently, including taking
prescribed medications.

Tailored Responses
In Los Angeles, repeat calls for service led to the
creation of the Case Assessment and Management
Program (CAMP), which is a response strategy that
focuses on proactive efforts to resolve the issues that
generate repeat calls to police and others, including
mental health case management and rigorous followup. CAMP teams include detectives from the police
department and mental health clinicians, who work
together to create customized plans for identified
individuals. The CAMP team, which is located in the
MEU area of the police department, receives referrals
from many sources, including SMART officers, the
Los Angeles Fire Department, school police, other city
police officers, other LAPD detectives/investigators,
and from mental health department personnel.

The outreach team allows officers
to see people when they are not in
crisis—to see them as people. It
also allows the consumers to have
a positive and compassionate
experience with the officers.”
—Helen Reedy
Member, NAMI-Ohio

There is pressure to handle a
high volume of calls for service,
and short-term fixes are often
a reality. The outreach team
follow-up with a consumer allows
the police to start implementing
longer-term solutions.”
—Sgt. Michael Yohe
CIT Coordinator, Akron (Ohio)
Police Department

From the Field: Program Design in Action

31

In Akron, a similar experience with “repeat callers” prompted the creation of CIT
Outreach Teams, which consist of a law enforcement officer who partners with a mental
health case manager to conduct follow-up with consumers in the community. This is not a
routine assignment for the officers; they must choose it as an off-duty assignment. Outreach
Team assignments come from referrals from mental health service providers, probation
officers, and from law enforcement officers who identify individuals who would benefit from
follow-up visits. The CIT coordinator at Community Support Services (CSS) prioritizes the
referrals based on mental health and criminal justice history. A list of repeat call locations is
also provided for follow-up and prevention efforts. Follow-up visits can result in a transport
to CSS, where psychiatrists or case workers can provide additional treatment and support, or
directly admit the individual to a hospital.
PROGRAM EXAMPLE: Responding to homelessness, Fort Lauderdale (Fla.)
Given that a large number of homeless individuals suffer from mental health issues, Fort
Lauderdale (Fla.) created a Homeless Outreach Unit to bring shelter, assistance, and understanding to the homeless population. The outreach team includes an officer and a mental
health worker who try to address the myriad needs of the “homeless mentally ill population.”
The officer’s assignment is voluntary because participating in the program requires a sincere
compassion and commitment to assist people in crisis. The team’s officer confirmed that
“these people have complex problems, they need medications they cannot afford, and the
team needs to empathize with them.”
The team gets referrals from law enforcement officers, but also establishes a pick-up location for three hours each day to assist people who are homeless or have just been released
from long-term programs. The officer interviews them and tries to link them with social services and shelters.33

I have responded to fewer CIT calls
over time because of the positive
effect of the outreach teams in
decreasing repeat callers.”
—Officer Lori Natko
CIT Officer, Akron (Ohio)
Police Department

The outreach teams served as a
natural complement to the CIT
program. Referrals did not only come
from mental health service providers,
but also from officers who identify
individuals that would benefit from
follow-up visits.”
—Ragan Leff
CIT Coordinator, Community Support
Services (Akron, Ohio)

CAMP team members develop responses on a case-by-case basis, and they range considerably.
For complex cases, we conduct home visits—as often as daily—to link the person to services,
in their home if needed, and obtain consent for our clinicians to speak to the person’s
psychologist to check on whether the person is making and keeping appointments.”
—Detective Teresa Irvin
CAMP Coordinator, Los Angeles (Calif.) Police Department

33. The information presented in this program example was developed based on a phone interview conducted
during the information-gathering phase of this project. For more information about the Fort Lauderdale
Homeless Outreach Unit, see the profile available on the Local Programs Database at www.cjmh-infonet.org/
main/show/2071.

32

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

The Impact of Jurisdictional Characteristics
on SPR Programs
Specific Jurisdictional
Characteristic Characteristics
Law
Enforcement
Agency

Mental Health
System

State Laws

Jurisdictions

SPR Activities

Leadership style is consistent
with “specialist” approach

Akron, Ohio
Fort Wayne, Ind.
Los Angeles, Calif.
New River Valley, Va.

A subset of self-selected law enforcement
officers are assigned to teams.

Leadership style is consistent
with “generalist” approach

Los Angeles, Calif.
New River Valley, Va.

All officers receive training in basic
de-escalation and recognizing mental illness.

Conducted Energy Devices
(CEDs) are used broadly as part
of departmentwide use-of-force
protocols

Akron, Ohio

Only CIT officers are provided with CEDs.34

Conducted Energy Devices
(CEDs) are used infrequently as
part of departmentwide use-offorce protocols

Fort Wayne, Ind.

CIT officers are not provided with CEDs.

Medical clearance is required
before admission to a mental
health facility

Fort Wayne, Ind.

Hospital emergency room protocols provide
quick medical and mental health assessments
in a secure area.

Mental health resources are
extremely limited/inaccessible

New River Valley, Va.

Officers are trained to identify better
those in need of emergency mental health
assessments.

Involuntary emergency mental
health assessment requires
extended police custody

New River Valley, Va.

Officers are trained on de-escalation to enable
them to manage safety concerns during
custodial period.
Law enforcement officers can be stationed at
an emergency psychiatric facility to receive
custody from patrol, freeing them to return to
routine duties.

Demography
and
Geography

Large, urban jurisdictions

Los Angeles, Calif.

SMART units are assigned specific areas of
responsibility and work in conjunction with
the more than 800 officers who receive some
mental health training to provide citywide
coverage. All officers receive some online
training.

Small, rural jurisdictions

New River Valley, Va.

The forces of multiple jurisdictions are
combined to increase the number of trained
officers who can respond to a large area.

Medium, urban jurisdictions

Akron, Ohio

Department trained 19 percent of total sworn
personnel in the department to respond.

Fort Wayne, Ind.

Department trained nearly 20 percent of
total sworn personnel in the department to
respond.

34. Although accurate at the time of the interviews in 2007 and 2008, both the Akron Police Department and Fort Wayne Police
Department have since revised their respective policies on CEDs. See page 35 for more information about the evolution of these
changes.

From the Field: Program Design in Action

33

Tailoring Specialized Policing Response Programs to
Jurisdictional Characteristics
As distinct from the previous discussion about problems and their impact on the specialized
response program, jurisdictional characteristics are largely static features in a community
or agency, which policymakers and planners must consider in program design and
implementation. (These are reviewed briefly in Section I.) The following discussion examines
how the jurisdictional characteristics, such as those outlined in the summary chart on
the previous page, shaped program responses. These factors include law enforcement
agency characteristics (such as leadership and use-of-force protocols), mental health system
characteristics (such as resources and medical clearance requirements), state law (such as
those regarding emergency custody orders), and demographics and geography.
Jurisdictional characteristic: Law enforcement agency leadership
The predominant law enforcement agency characteristic that affected program development
in the four studied sites was leadership style. According to those interviewed at the study
sites, at the foundation of these preferences are law enforcement chief executives’ opinions
about the necessity of particular personality traits among personnel for carrying out specific
tasks. For example, many in the field report that there are senior law enforcement officials
who believe that officers trained for the specialized response, particularly special units,
should be volunteers, self-selected to have compassion for people with mental illnesses.
Others may feel that all first-responders should be educated about mental illnesses and
trained to de-escalate crisis situations using appropriate procedures. Still others believe
that some basic training for all first-responders is in order, with more intensive preparation
for voluntary special unit personnel. Though
concerns about training budgets, priorities
for limited resources, size of jurisdiction, and
other factors may be considered in determining
who is trained and dispatched, many of the
Not all officers can be CIT
officers, because it requires
individuals interviewed in the study sites felt that
a personal commitment and
the perspective of the agency’s leaders largely
compassion that cannot be
determined how the response would be shaped.
taught or forced. Still, because
the skills are so generalizable,
they can be applied, in part,
Tailored Responses
on calls such as responding to
Each of the four jurisdictions developed training
people with mental retardation
approaches that were consistent with the agency
and developmental disabilities,
leader’s style. This was most notable in the regional
domestic violence calls, or
New River Valley CIT program, where variation
people who are intoxicated—
all officers should have a basic
exists among the police leadership in the fourteen
understanding of them.”
jurisdictions involved in the program. Each
—Lt. Richard Edwards
jurisdiction determines which and how many of
Public Information Officer, Akron
its officers will be trained, resulting in differences
(Ohio) Police Department
among them. Leaders in the Los Angeles Police

34

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Department chose to provide some training on mental
health issues to all patrol officers (twenty-four hours)
because all officers must be prepared to handle the
wide range of calls to which they respond. This agency
also provides a full forty hours of “specialized” training
to officers involved in its MEU, SMART, and CAMP
strategies, and officers who receive CIT training for use
in designated areas of the city.
Jurisdictional characteristic: Law enforcement agency

use-of-force protocols
Department policies and practices on the use of force,
particularly less-lethal technologies, also can play a
role in program design. Police agencies must develop
policies on how and when officers use a range of force
options through a complex and careful process that takes
into account factors such as officer training and the
circumstances during the encounter. Many communities
are grappling with the use of conducted energy devices
(CEDs), such as Tasers,™ during encounters with people
with mental illnesses as a way to reduce the likelihood of
serious injury or death during these incidents.

Tailored Responses
These policies differed significantly across jurisdictions
visited for this study. For example, at the time of the
site visits, the Akron Police Department provided CEDs
only to CIT-trained officers, and the Fort Wayne Police
Department never provided them to CIT officers. These
policies have since changed, but the thinking behind
these early policies on CEDs can be instructive for other
agencies. Akron believed that the training provided to
CIT officers uniquely positioned them either to use the
device very judiciously or to de-escalate a situation so that
a CED would not be needed. (Since the time of the visit,
Akron has extended the use of CEDs to other officers
with proper training.) In contrast, Fort Wayne believed that
officers trained in CIT would be the least likely to need the
device due to their training in de-escalation and that backup
could be provided by another patrol officer on the scene. Fort
Wayne Police Department leaders have since decided that

Tasers™ are critical to the success
and safety of CIT. Although
applying CIT knowledge and
communications skills are
highly effective at de-escalation,
no technique is 100 percent
reliable. Having a less-lethal
option available to CIT officers
is an obvious way to increase
everyone’s safety in handling
many crisis calls. This is especially
true considering that a significant
number of these calls involve
suicides-in-progress, and Tasers™
may provide one of the few
options to safely stop individuals
from harming themselves. The
conversation about less-lethal
devices must be tied in with the
CIT conversation.”
—Sgt. Michael Yohe
CIT Coordinator, Akron (Ohio)
Police Department

Though the Fort Wayne Police
Department did not prioritize
Tasers™ for CIT officers, in part
because they could be provided
backup by other officers, they
now have the same opportunity
to request and train for the use of
these less-lethal devices.”
—Deputy Chief Dottie Davis
Director of Training, Fort Wayne (Ind.)
Police Department

From the Field: Program Design in Action

35

CIT training will not be a determining factor when
selecting who in the department will be issued a
CED.
If a department’s leadership team decides
that CEDs can make situations involving people
with mental illnesses safer for all involved, law
enforcement should work with their partners to
develop protocols and policies, appropriate training,
and supervision.35
Jurisdictional characteristic: Mental health

resources
Specialized policing response programs hinge on the
availability of mental health resources to serve as an
alternative to criminal justice system involvement
when warranted. Although some communities
manage to increase the available mental health
resources, or shift them, many communities must
work with what resources are available in their
jurisdiction. As a consequence, stakeholders must
develop strategies to manage increases in volume that
result from law enforcement transports or referrals.
Among the issues to be considered are whether any
changes can be made in triaging to ensure the highest
levels of care match those most in need, evaluating
admission criteria and accessibility issues, easing
contact and increasing efficiency for law enforcement
personnel, and addressing any commensurate
increases in costs related to caring for people with
mental illnesses at risk of continued criminal justice
involvement, many of whom are uninsured.

The main problem in Los
Angeles is a lack of available
resources—even trained officers
have nowhere to transport
individuals. Not only can
the officers not transport
anyone, there are no services to
recommend to family members
anymore. Psychiatric emergency
rooms and psychiatric inpatient
units are located in the county
hospital, and one county
hospital has closed completely.”
—Nancy Carter
Executive Director, NAMI–Urban
Los Angeles (Calif.)

The number of scenarios that
involve custody was a lot
more before the CIT training.
Officers can now better identify
people who need to be taken
into custody because they
know what to look for. Fewer
people are taken into custody,
and more people are taken
appropriately.”
—Officer Danny Ratcliffe
CIT Officer, Pearisburg (Va.)
Police Department (NRV)

Tailored Responses
In Los Angeles and New River Valley, specialized
policing response programs reduce some demands
on limited mental health resources by relying on

35. For more information about standards and guidelines for CED use, the Police Executive Research Forum
(PERF), with support from the Office of Community Oriented Policing Services (COPS Office), has created a
resource on the topic. See James M. Cronin and Joshua A. Ederheimer, Conducted Energy Devices: Development of
Standards for Consistency and Guidance (Washington, DC: U.S. Department of Justice, Office of Community Oriented
Policing Services and Police Executive Research Forum, 2006), www.ojp.usdoj.gov/BJA/pdf/CED_Standards.pdf.

36

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

well-trained officers and effective information-gathering
to help properly assess individuals’ need for emergency
evaluations, and whenever possible, connect people
with care providers outside of the emergency response
networks. As mentioned previously, in Los Angeles, the
SMART officers work with their triage unit to access a
database with an individual’s history while the forensic
nurse in this unit can access the mental health records.
In the New River Valley, CIT officers are trained to
screen people for the need for hospitalization, so fewer
people are taken into custody. In both jurisdictions,
law enforcement is working with the mental health
community to make the most of limited resources.
In one hospital in Fort Wayne, the volume of mental
health patients increased significantly as a result of
the implementation of the CIT program. The number
of twenty-four-hour mental health assessment holds
brought to the hospital by police doubled—from 600
in 1998 to 1,200 in 2007. The stakeholders in this
community also eventually determined that a subgroup
of people had been invoking a seventy-two-hour hold
repeatedly when they did not have a mental illness.
These individuals had primary substance abuse issues
and many were attempting to avoid arrests for DUI.
The facility arranged with the judge who oversees the
commitment hearings to limit the number of times a
person could be admitted consecutively based on an
emergency custody order to eliminate those who were
not in need of mental health treatment. This resulted
in increased availability of services for those who
appropriately needed mental health care.
To manage costs, the inpatient mental health
providers in Fort Wayne have developed a mechanism to
enroll people in benefit programs, such as Medicaid. The
hospital contracts with a for-profit business that charges a
fee to enroll qualified individuals in Medicaid programs.
The contractors working at Parkview Behavioral Health
have converted 52 percent of the people who were
admitted without insurance to become covered by
Medicaid, which has significantly reduced the hospital’s
burden of providing uncompensated care.36

Clinicians now recognize the
CIT officer and take more stock
in what a CIT officer is saying.
The clinicians also recognize the
added benefit that the officer
provides by de-escalating the
situation before the clinician gets
there.”
—Deputy Chip Shrader
Montgomery County (Va.)
Sheriff’s Office (NRV)

The biggest fear was that this
was going to cost more money.
Parkview became creative
with funds and implemented
programs—with social workers
getting . . . Medicaid for clients—
to get the ball rolling.”
—James White
Service Coordinator/Security
Lead Staff, Park Center Inc.
(Fort Wayne, Ind.)

The other issue that providers
need to be aware of is that this
will impact their payer mix—
many people in this population
are underinsured or not insured. If
you are using the ER as the access
point, this can be costly.”
—Chuck Clark
Executive Director, Parkview
Behavioral Health (Fort Wayne, Ind.)

36. For more information about connection to federal benefits, particularly for people with mental illnesses
who are returning to the community from prison or jail, see www.reentrypolicy.org/issue_areas/reentry_
federal_benefits.

From the Field: Program Design in Action

37

Although the communities visited were
not able to create entirely new mental health
resources, they were successful in maximizing the
use of existing resources through two particular
strategies: First, planners stretched resources
by training officers and others to identify more
accurately those people who needed emergency
mental health services. Second, planners
developed strategies to enroll qualified individuals
in benefits programs to improve payment of
needed mental health services. In the New River
Valley, law enforcement agencies also shared
resources throughout the region, making it easier
to access and sustain them.

The biggest challenge is
bringing all the people in
through the ER. The ER was
identified as the access point
for all psychiatric patients; it
is expensive and not best for
patients to have to wait three or
four hours for an assessment.”
—Chuck Clark
Executive Director, Parkview
Behavioral Health (Fort Wayne, Ind.)

Jurisdictional characteristic: Medical clearance requirements
In the New River Valley and in Fort Wayne, mental health system stakeholders were hesitant
to accept someone into a mental health facility who might have a medical condition that
requires priority treatment. This concern is shared by many communities across the country,
and program models typically require law enforcement officers to transport the person in
mental health crisis first to a hospital emergency room for medical clearance. In these cases,
mental health services are provided after a physician determines the person is well enough
for psychiatric assessment.
The necessity of medical clearance requires program planners to develop procedures to
guarantee a safe and timely medical assessment, to ensure the safety needs of other patients
and staff, and to create a smooth transition to the appropriate mental health resource.

Tailored Responses
In Fort Wayne, law enforcement officers bring the person in crisis to the emergency room
of the local hospital through the ambulance entry to one of three secure rooms. This allows
privacy and security. The individuals in the care of officers get priority treatment and
officers talk directly with the mental health counselors. Once the physician determines the
individual’s medical condition is stable, the mental health clinicians assess the needed level
of care.
To enable officers to return to other duties, the hospitals in Fort Wayne employ security
staff to monitor the patient’s safety and the safety of others in the emergency room. The
hospital worked with their legal counsel to develop clear guidelines on holding, restraining,
and detaining patients, and to make sure that hospital security is not held liable for injuries
that may result. Although the goal in these hospitals is to err on the side of protecting
patients from harming themselves or others, their care, dignity, and privacy were considered
in developing these guidelines.

38

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Jurisdictional characteristic: State laws
Requirements in state laws regarding law enforcement
officers’ role in emergency mental health evaluations
must be addressed in designing and implementing
specialized policing responses. These laws may affect
program design by mandating certain types or the
scope of training. They can also spell out under what
circumstances officers are permitted to transport or
take into custody individuals with mental illnesses who
meet specific standards (such as imminent harm to
themselves or others).

In 2008, hospitals were faced
with national patient safety goal
#15, which requires a system for
screening patients for suicide
risk. They must be screened
appropriately and the hospital
must provide ‘continuity of care’
so that when the person returns
to the community it must be with
a safety net in place.
Mental health clients are no
longer what we do at the end of
the day when we are done with
everything else. This hospital is
now making psychiatric services a
priority and we are committed to
quality services.”

Among the many state mandates that can affect
program design, the one that was most at issue in
the four-site study involved officers taking custody
of individuals with mental illnesses for emergency
evaluation. As described, in Virginia, for example, a
—Deb Richey
Nursing Director of Emergency
law enforcement officer is authorized to determine if
Services, Parkview Hospital
a person meets the criteria for an “emergency custody
(Fort Wayne, Ind.)
order” (ECO) without taking the person in front of a
magistrate. The ECO lasts up to six hours (previously
mandated at four hours), and state law requires that
the officer maintain custody of the person with mental illness while they wait for a mental
health crisis worker to arrive and complete a mental health assessment, and find a treatment
bed if needed. Officers may not detain the person in jail during this time, which means law
enforcement agencies must designate a place where the officer can stay with the person in
crisis until a clinician arrives. Oftentimes, this space becomes a multipurpose room (the
same area may serve as a waiting area for a person who has been served a warrant and for
someone who has come to the department to report a crime). If the six-hour period elapses
without an assessment or an available place for treatment, the person must be released.
During the ECO time period, crisis workers assess the person’s status, gather collateral
information, and decide if the person meets the criteria to be committed. If the criteria are
met, the clinician tries to facilitate an admission to an inpatient facility—either into a public
or private facility—or diverts the individual back to the community to receive services and
supports. The majority of the calls are handled within the six-hour period.

Tailored Responses
One goal of the New River Valley CIT program is to address the strain on law enforcement
personnel created by this law. At this writing, there is legislation in place in Virginia that
would allow for a CIT officer to be stationed in the hospital emergency room to accept
custody of the incoming person in mental health crisis, and allow the transporting officers to
return to patrol. Alternatively, if the hospital has a police or security department of its own,

From the Field: Program Design in Action

39

the new legislation allows “willing and able”
hospital security staff to extend their duties to
include managing the ECO process.37
For law enforcement officers in Fort Wayne,
the ECO under state law has been limited to
a twenty-four-hour hold and it has been an
effective tool for reducing the time officers
spend waiting at community facilities with
people who need a mental health assessment.
This statute was originally underutilized
because officers were not comfortable making
decisions regarding mental health assessment
criteria. Now that they have received specialized
training on the issue, they are more likely to
invoke the ECO law that authorizes them to
transport that person to the emergency room
without the officer needing to retain custody.
Although this ECO is designed primarily for
medical observation, it can be converted into a
seventy-two-hour commitment for mental health
evaluation upon judicial order.

There was a statutory twentyfour-hour hold on the books
since 1969. The reason it was not
used was because police officers
were not trained. Before CIT,
officers had to wait hours with
the person in crisis until a mental
health professional could come
and conduct the assessment.
Now, along with CIT, we are
using this hold so that officers
have the authority to take the
person to a mental health facility
for assessment, where better
procedures reduce the amount of
time officers must wait with the
person. This has added a great
efficiency to our processes.”
—James White
Service Coordinator/Security
Lead Staff, Park Center Inc.
(Fort Wayne, Ind.)

PROGRAM EXAMPLE: Working collaboratively to meet legal guidelines,
Lincoln (Nebr.)38

In Nebraska, law enforcement and correctional officers are the only authorities who can
take people into emergency protective custody (EPC) for involuntary mental health evaluation. Within thirty-six hours, a county attorney will determine whether to proceed with the
involuntary commitment process. Nebraska is divided into six regions, each of which has a
dedicated facility to receive people placed into EPC by law enforcement. Police officers in the
City of Lincoln have round-the-clock access to mental health professionals in their region to
assist them in deciding whether the person warrants custody or to determine an appropriate alternative. The Lancaster County Mental Health Agency, which serves Lincoln, is available
24/7 either by phone, in-person in the field, or at the police station. The officer can also take
individuals directly to the mental health agency during business hours.
The City of Lincoln has also created a new process that has reduced by half the number of
EPC orders officers do in a year. The key is to provide information to officers in the field about
consumer involvement in programs like Assertive Community Treatment (ACT) to maintain
their connection to these programs. Consumers can sign a waiver to put their participation
in ACT in a police database. When officers conduct a routine warrant search, they get a message to contact the person’s case manager, rather than taking the person into the emergency
mental health system, where they will have to start over.

37. At press time, this legislation had been passed and the leadership in New River Valley were working toward
implementing this practice.
38. The information presented in this program example was developed based on a phone interview conducted
during the information-gathering phase of this project. For more information about the Lincoln Police
Department’s efforts, see the profile available on the Local Programs Database at www.cjmh-infonet.org/main/
show/2103.

40

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Jurisdictional characteristic: Demography and

geography
A jurisdiction’s population size and density, land area,
traffic patterns, and crime problems present important
constraints on specialized responses. Jurisdictions of
all sizes, particularly those at either end of the range,
struggle with the adequacy of community-based
resources, the ease of accessing them, and the allocation
of officers to work with them.

[One] reason larger cities are
challenged to maintain CIT is
because geography and the
sheer number of calls to which
they must respond can prohibit
relationship-building. With
three county hospitals, CIT
police officers are unable to form
necessary relationships with
hospital personnel because they
are limited by time.”
—Linda Boyd

Tailored Responses
In Los Angeles, one of the strategy impetuses was
concern over safety for all individuals involved in
police encounters, which resulted in recommendations
to implement CIT. However, the size of the police
department limited the agency’s ability to train the
recommended benchmark of 20 percent of the officers
to work full time on crisis intervention calls.39 The
jurisdiction’s large geographic area also made deploying
the CIT-trained officers difficult. They found during pilot
testing in one area that the 20 percent of the officers
they were able to train in just that district still were
only able to respond to 20 percent of the calls involving
people with mental illnesses. In large part, this occurred
because transportation to psychiatric emergency centers
kept CIT officers in the hospital for three to four hours,
unable to respond to other mental health calls.

Manager of Law Enforcement Mental
Health Programs, Department of
Mental Health, Los Angeles County
(Calif.)

My officers can spend up to twelve
hours on night shift dealing with
a call involving a mental health
assessment. This is the biggest
problem our small department
faces. If we get taken on a call like
that, a whole shift is off-road all
night and we may only have two
or three deputies on duty.”
—Chief Jackie Martin
Pearisburg (Va.) Police Department
(NRV)

In response, LAPD tailored its strategy to focus
on the co-response model—increasing the number of
personnel assigned to SMART and expanding the hours
of operation. The co-responder teams are assigned
to patrol areas with overlapping response protocols, which ensures citywide coverage. The
linchpin to this strategy is the MEU “triage desk,” with staff that provides advice to primary
responders, dispatches SMART units, controls the flow of individuals who have received
law enforcement responses to county psychiatric emergency departments, and maintains a
database of law enforcement contacts. In addition, Los Angeles decided to train all officers
with twenty-four hours of online training on crisis intervention tactics, and the department
offers a CIT course each quarter that is open to all first-responders, although priority is
given to those officers most likely to encounter people with mental illnesses. This training

39. The recommendation to train 20 to 25 percent of a law enforcement agency is proposed by the CIT Center
at the University of Memphis in the “Crisis Intervention Team Core Elements,” http://cit.memphis.edu/
CoreElements.pdf.

From the Field: Program Design in Action

41

is a key component of LAPD’s strategy because
any officer may encounter someone whose mental
illness is a factor in the call for police involvement.
The department’s leaders believed all officers would
benefit from knowledge of these techniques. So the
LAPD based its decisions to build a multi-tiered
response model on the size of the jurisdiction, data
that identified a particular geographic area that
generated repeat calls for service, leadership style, and
many of the other characteristics discussed previously.
The New River Valley CIT brought together
fourteen jurisdictions in its area because they all fell
within one of Virginia’s mental health catchment
areas.40 The goal of bringing the smaller, rural
communities together was to capitalize on shared
resources. For example, agencies created agreements
to allow officers to cross jurisdictions and serve each
other’s residents, and planned to train 25 percent of
the total number of patrol officers from the combined
forces to have sufficient coverage of shifts and
geography.
In New River Valley, these communities have
focused on developing better relationships between
law enforcement and consumers of mental health
services. Because of the CIT program and officer
training, stakeholders note that consumers are less
reluctant to interact with law enforcement officers, are
less fearful of officers, and even recognize CIT officers
as helpful. Although this improved relationship may
not change the fact that law enforcement must stay
with the person for up to six hours, and may not have
a nearby facility to take them, it does help officers
communicate with consumers and understand how to
resolve problems. According to those interviewed in
the study site, the improved rapport and trust between
officers and clinicians, consumers, and citizens who
call for assistance has also boosted the credibility of
law enforcement observations in the eyes of mental
health professionals.

One of the advantages to large
jurisdictions is that there are
many resources to tap and many
community members to assist
and many officers committed to
working with this population.”
—Chief William Bratton
Los Angeles (Calif.) Police Department

The very nature of the rural
community creates challenges—
the distances are long and
there is almost no public
transportation [to help people
access services easily].”
—Harvey Barker
Director, New River Valley (Va.)
Community Services (NRV)

It used to be mental health on
one side, law enforcement on
the other. They looked at us
as yanking people out, and we
looked at them and thought:
I’ve had to fight this guy to get
him to the department and you
want to be all touchy feely. The
trip we all took to Memphis
brought us together and created
a lasting bond. We gained a lot
of respect for each other during
that time.”
—Deputy Chip Shrader
Montgomery County (Va.)
Sheriff’s Office (NRV)

40. Because mental health services are organized along different geographic lines than law enforcement
services, it can be difficult to develop coordinated service delivery strategies. Jurisdictions need to consider
their respective catchment areas when setting up collaborative initiatives.

42

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

PROGRAM EXAMPLE: Tailoring to a large rural region,
Piscataquis County (Maine)41

Piscataquis County (Maine) is the only “frontier county” east of the Mississippi. According to
Sgt. Robin Gauvin of the Portland, Maine, Police Department, this equates to a population
density of less than one person per square mile. This county has three municipal police departments that determined a need to improve their response to people with mental illness in this
rural area. This program has focused on creating force multipliers to boost the law enforcement response capacity.
For example, in 2003 the law enforcement agencies began partnering with Emergency
Medical Services so that ambulances co-respond with police on situations involving someone
with a mental illness. When an area has only one deputy in charge of 400 square miles, this
agreement translates to the addition of three or four emergency medical technicians who can
be called upon to assist. The involvement of the ambulance staff assists with de-escalation
and transportation. The officer can arrive at a scene within ten minutes and an ambulance
can arrive in twenty to thirty minutes, but mobile crisis workers would take more than an
hour to reach most areas. Call takers and dispatchers are also part of expanding capacity to
respond. They are now trained to ask for more information, give options to help, and ask questions once thought dangerous to ask a caller expressing thoughts of suicide.

Conclusion
SPR program development should be guided by both the problem in the community and
the specific characteristics of the jurisdiction. There is no “one-size-fits-all” response that
will work in every community. It is vital that leaders in law enforcement, mental health,
and consumer advocacy understand what obstacles there are to providing sensitive and
appropriate responses to people with mental illnesses, and then assess what resources and
agency strengths can overcome them.
The program activities presented in this guide hint at the efforts being made around
the country to improve law enforcement responses to people with mental illnesses. They
should not be considered a complete catalog of all possible options, but rather are included
to highlight common themes and promising approaches to problems faced by agencies with
varying demographics. The examples from the sites, and the discussions of selected problems
and factors that should influence program planning, are provided to underscore the need
to truly understand what responses will make the most sense in a particular jurisdiction. It
is hoped that policymakers and planners from any agency can use this guide as a starting
point to design or enhance a SPR program that will result in better outcomes for people
with mental illnesses, a more effective and rewarding use of law enforcement resources, and
improved safety of all involved in these encounters.

41. The information presented in this program example was developed based on a phone interview conducted
during the information-gathering phase of this project. For more information about the Piscataquis Sheriff’s Office
Crisis Intervention Team, see the profile available on the Local Programs Database at www.cjmh-infonet.org/
main/show/3137.

From the Field: Program Design in Action

43

Appendix A
Site Visit Information
Titles and agency affiliations reflect the positions held at the time the interviews were
conducted.

Akron (Ohio)
Site Visit Dates: December 5–7, 2007
Interviews Conducted
• Chief Michael Matulavich, Akron Police Department
• Lieutenant Richard Edwards, Public Information Officer, Akron Police Department
• Lieutenant Mike Woody (retired), Law Enforcement Liaison, Ohio Criminal Justice
Coordinating Center of Excellence
• Sergeant Michael Yohe, CIT Coordinator, Akron Police Department
• Officer Lori Natko, CIT Officer, Akron Police Department
• Officer Forrest Kappler, CIT Officer, Akron Police Department
• Ms. Lorie Witchey, Dispatcher, Akron Police Department
• Dr. Mark Munetz, Chief Clinical Officer, Summit County (Ohio) Alcohol, Drug
Addiction and Mental Health Services Board
• Kim Shontz, Director of Outpatient Services, Community Support Services
• Joan “Ragan” Leff, CIT Coordinator, Community Support Services
• Ron Rett, Member, NAMI–Ohio
• Mel and Helen Reedy, Members, NAMI–Ohio
• Bernie, Consumer

Fort Wayne (Ind.)
Site Visit Dates: February 20 –21, 2008
Interviews Conducted
• Deputy Chief Dottie Davis, Director of Training, Fort Wayne Police Department
• Officer Mark Bieker, CIT Officer, Fort Wayne Police Department
• Teresa Hatten, President, NAMI–Indiana
• Jane Novak, Member, NAMI–Indiana
• Deb Richey, Nursing Director of Emergency Services, Parkview Hospital (Fort Wayne)
• Marcy Malloris, Transitional Care Services Manager, Park Center Inc. (Fort Wayne, Ind.)
• James White, Service Coordinator/Security Lead Staff, Park Center Inc. (Fort Wayne, Ind.)

Appendix A: Site Visit Information

45

•
•
•
•
•
•
•
•

Chuck Clark, Executive Director, Parkview Behavioral Health (Fort Wayne)
Patsy Hendricks, Director of Clinical Services, Parkview Behavioral Health (Fort Wayne)
Amy Tyler, Director of Behavioral Health, St. Joseph Hospital (Fort Wayne)
Joe Louraine, Assessment Specialist, St. Joseph Hospital (Fort Wayne)
Andy Wilson, Executive Director, Carriage House (Fort Wayne)
Tom, Consumer, Carriage House (Fort Wayne)
John, Consumer, Carriage House (Fort Wayne)
Joe, Consumer, Carriage House (Fort Wayne)

Los Angeles (Calif.)
Site Visit Dates: December 11–14, 2007
Interviews Conducted
• Chief William Bratton, Los Angeles Police Department
• Assistant Chief Jim McDonnell, 1st Assistant Chief, Chief of Staff, Los Angeles
Police Department
• Assistant Chief Earl Paysinger, Director, Office of Operations, Los Angeles
Police Department
• Commander Harlan Ward, Assistant Commanding Officer of Valley Bureau,
Los Angeles Police Department
• Captain Ann Young, Commanding Officer, Detective Support and Vice Division,
Los Angeles Police Department
• Lieutenant Rick Wall, Mental Evaluation Unit, Los Angeles Police Department
• Lieutenant Michael Albanese (ret.), SWAT Commander, Los Angeles Police Department
• Detective Teresa Irvin, CAMP Coordinator, Los Angeles Police Department
• Dr. Luann Pannell, Director of Police Training and Education, Los Angeles
Police Department
• Dr. Tony Beliz, Deputy Director, Emergency Outreach Bureau, Department of
Mental Health, Los Angeles County
• Linda Boyd, Manager of Law Enforcement Mental Health Programs, Department of
Mental Health, Los Angeles County
• Nancy Carter, Executive Director, NAMI–Urban Los Angeles
• Jim Randall, President, NAMI–San Fernando Valley
• Mark Gale, Member, Board of Directors, NAMI–California

46

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

New River Valley (Va.)
Site Visit Dates: March 6–7, 2008
Interviews Conducted
• Victoria Cochran, Chair, State Mental Health, Mental Retardation and
Substance Abuse Services Board
• Chief Jackie Martin, Pearisburg Police Department
• Chief Gary Roche, Pulaski Police Department
• Lt. Brad St. Clair, Montgomery County Sheriff’s Office
• Deputy Chip Shrader, Montgomery County Sheriff’s Office
• Officer Danny Ratcliffe, CIT Officer, Pearisburg Police Department
• Patrick Halpern, Executive Director, Mental Health Association of the
New River Valley, Inc.
• Dr. Harvey Barker, Executive Director, New River Valley Community Services
• Marie Moon Painter, Clinical Team Leader for CONNECT, Carilion St. Albans
Behavioral Health

Appendix A: Site Visit Information

47

Appendix B
Document Development
This document was developed based on information gathered in several communities
throughout the country, which were selected to represent a range of characteristics—diverse
objectives, jurisdiction sizes, and program models. The site selection process began with an
in-depth review to identify jurisdictions with an active law enforcement-based specialized
response program—including mining the Local Programs Database, examining literature
published on existing programs, and consulting with national experts. Once a comprehensive
list was compiled, programs were screened for inclusion based on three important features—
the program had to be law enforcement-based, in existence for at least five years, and designed
independently based on the jurisdiction’s specific circumstances.

Why these three characteristics?
1) Many communities have developed teams of community mental health professionals,
such as mobile crisis or assertive community treatment teams, to assist officers at
the scene. Although these models are undoubtedly a valuable resource for many
communities and departments, they do not require significant policy and procedural
changes in the law enforcement agency, and therefore are not law enforcement-based
and are not within the scope of this document.
2) Anecdotal evidence suggests that during the first five years of an initiative, program
practices and policies undergo an iterative process of development, building on the
program’s successes and failures over time. Based on this finding, jurisdictions needed
to have an operational program for at least five years to be considered.
3) Several state governments have coordinated efforts to proliferate a specific model
throughout jurisdictions in their state. These states should be applauded for these
efforts, but jurisdictions that selected and implemented a program based on state
policymakers’ influence did not go through an independent program design process.
Because the intention of this report is to identify and describe the various methods
of program design, only jurisdictions that designed the program based on specific
circumstances and characteristics were included.

Appendix B: Document Development

49

The initial screening process left a short list of jurisdictions that fit the three primary
criteria. Interviews were conducted with representatives from the remaining programs, and
were centered on four main questions:
1. How was the program developed?
2. Is there a priority population involved in the strategy?
3. What is the nature and strength of the criminal justice/mental health collaboration?
4. How are data collected and analyzed?
Information gleaned from these telephone interviews was considered in the context
of remaining selection criteria: variation in program model and jurisdiction type (e.g.,
demographic features and geography), mental health delivery styles, field familiarity (e.g.,
highlighting less-known programs), and usefulness and applicability to the field. Based on
this review process, Akron (Ohio), Fort Wayne (Ind.), Los Angeles (Calif.), and New River
Valley (Va.) were selected to be visited for this report.

50

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Appendix C
Program Design Worksheet
Step 1: Understand the problem
1. What forces are driving current efforts to improve the law enforcement response to
people with mental illnesses?
2. What data can planning committee members examine to understand the factors
influencing law enforcement responses to people with mental illnesses?
3. What are the data limitations, and how can they be overcome?

Step 2: Articulate program goals and objectives
1. What are the program’s overarching goals?
2. What are the program’s objectives?

Step 3: Identify data-collection procedures needed to revise and
evaluate the program
1. What data will be collected to measure whether goals and objectives
have been achieved?
2. What data collection strategies will be used?

Step 4: Detail jurisdictional characteristics and their influence on
program responses
1. What characteristics of the law enforcement agency are relevant in planning a
specialized response to people with mental illnesses?
2. What mental health system characteristics are relevant in planning a specialized
response to people with mental illnesses?
3. What state laws are relevant in planning a specialized response to people with mental
illnesses?
4. What demographic and geographic community characteristics are relevant in planning
a specialized response to people with mental illnesses?

Appendix C: Program Design Worksheet

51

Step 5: Establish response protocols
1. What law enforcement responses are necessary?
2. What mental health system responses are necessary?
3. What other responses or resources are necessary?

Step 6: Determine training requirements
1. How much training will be provided and to which law enforcement personnel?
2. What topics should training cover?
3. Who will provide the training?
4. What training strategies will be employed?

Step 7: Prepare for program evaluation
1. What resources need to be set aside or identified for an evaluation?
2. Are there individuals designated to oversee the evaluation?

52

Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Council of State Governments
Justice Center

www.justicecenter.csg.org