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The montgomery county CIT model: interacting with people with mental illness.

On a hot summer day in 1998, a man walked into the U.S. Capitol and killed two U.S. Capitol Police officers. The male, previously diagnosed as a paranoid schizophrenic, reportedly believed that he had been cloned at birth and had invented a machine to reverse time. He also believed that the CIA had been spying on him via satellite. (1) The assailant had numerous prior contacts with law enforcement and had been committed to a mental health facility prior to the killings. (2)

Sadly, this does not represent an isolated incident. During the years 1992 through 2001, 11 law enforcement officers in the United States were killed by assailants who were mentally ill. (3) Add these homicides to the 914 law enforcement officers assaulted by people with mental illness in the year 2001 alone and the magnitude of the problem becomes clear. (4) It is imperative for law enforcement agencies to train their officers to interact effectively and, most of all, safely with individ-uals who have mental illness.

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THE PURPOSE OF A CRISIS INTERVENTION TEAM

Primarily, the purpose of a crisis intervention team (CIT) is to provide law enforcement officers with the skills they need to safely de-escalate situations involving people with mental illness who are in crisis, not to turn officers into mental health workers. The term mental illness refers collectively to all diagnosable mental conditions characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress or impaired functioning. Alzheimer's disease exemplifies a mental illness largely marked by alterations in thinking (especially forgetting), whereas depression provides an example of an illness predominantly distinguished by fluctuations in mood, and attention deficit hyperactivity disorder typifies one mainly recognized by changes in behavior (over-activity) or thinking (inability to concentrate). Alterations in thinking, mood, or behavior contribute to a host of problems--patient distress and impaired functioning or heightened risk of death, pain, disability, or loss of freedom. (5)

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Crisis behavior results when individuals experience a temporary breakdown in coping skills, including perception and decision-making and problem-solving abilities. Healthy people often seek help from others to compensate for the temporary inability to cope. But, individuals with mental illness may experience the crisis more severely, be less likely to seek assistance from others, or not understand that they are in crisis. (6) A variety of situations can trigger a crisis behavior. Events ranging from the loss of a job, being locked out of a house, or being the victim of a crime illustrate incidents that can ignite crisis behavior in someone who has a mental illness. (7) An officer responding to a call for a noise disturbance may unknowingly walk into a situation involving a person with mental illness who is experiencing a crisis.

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THE MONTGOMERY COUNTY CIT MODEL

In 1999, the Montgomery County, Maryland, Police Department sought a way to peacefully resolve potentially violent encounters with persons who are mentally ill by taking a proactive approach and establishing the Montgomery County Police Crisis Intervention Team (CIT). The goal was to provide officers with the proper tools and skills to safely and effectively de-escalate critical incidents involving people with mental illness who are in crisis.

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The Montgomery County CIT program, initially modeled after the Memphis CIT program, (8) quickly evolved into an effective modern model for many East Coast law enforcement agencies. The program has three complementary components that have made it a success: the training component, the CIT officer component, and the CIT coordinator component. Agencies interested in establishing a similar program may want to consider these components, as well as some key legal issues.

The Training Component

The training component consists of three segments: basic, advanced, and less-than-lethal training and constitutes a collaborative effort involving Montgomery County's Police Department, Sheriff's Office, Department of Health and Human Services, Department of Corrections, and Mental Health Association, along with the local chapter of the National Alliance for the Mentally Ill and a nearby state hospital. All of the training takes into account the safety of the officers involved, as well as that of the individuals in crisis. Officers understand the importance of maintaining control of the situation to avoid the possibility of it escalating further. They also realize that any hesitation on their part to use force on individuals who may cause harm to themselves or to others can result in serious, life-threatening consequences to everyone at the scene, including the officers themselves.

Basic CIT Training

Basic training comprises a 40-hour block of instruction wherein officers receive both classroom and hands-on instruction. Professionals from the partnering mental health organizations teach various blocks of instruction, which cover the different types of mental illness, interview techniques, de-escalation strategies, and other relevant topics. The officers participate in a live "hearing distressing voices" exercise. This role-playing scenario provides them with a glimpse of what it is like to hear voices in their heads. Each officer wears a set of headphones and listens to the distressing voices for 1 hour while performing various tasks, such as walking to the store, changing a tire, or being interviewed. This exercise constitutes a major turning point in the training and an epiphany for many of the officers in understanding and empathizing with those who have mental illness. Afterwards, they visit a nearby Maryland hospital for individuals with mental illness where they meet the hospital staff and engage in a group discussion with patients who have had both positive and negative experiences with law enforcement when they were in crisis. The group discussions offer them a great insight into understanding how a person experiencing crisis behavior reacts to a law enforcement presence. The patients speak openly about their interactions with officers and often relate what triggered them to either fight or cooperate.

The basic training concludes with a full day of scenarios for the students. The role players are mental health professionals from the Montgomery County Department of Health and Human Services. The scenarios are videotaped, and each student receives a critique at the end of the session.

Advanced CIT Training

The advanced CIT training component provides CIT members with continuous information and knowledge to enhance their skills. The training involves a collaborative effort with a number of outside organizations that offer lectures and seminars on topics that relate to mental illness. The U.S. Secret Service's Protective Intelligence Unit invites CIT officers to attend its training seminars on assessing danger. The FBI's Crisis Negotiation Unit sponsors seminars on negotiation techniques and interviewing suicidal subjects for CIT members. A Maryland correctional facility (which serves as a mental hospital for offenders who have committed serious crimes, but, because of their mental illness, were found "not criminally responsible") provides a forum for group discussion between CIT officers and inmates.

Less-Than-Lethal Training

The less-than-lethal portion of the CIT program involves a patrol tactical plan for dealing with individuals in crisis. The plan, known as the Immediate Action Team, incorporates the department's less-than-lethal weapons into a standardized protocol for the coordinated deployment of the weapons. The department's less-than-lethal arsenal consists of Tasers (i.e., electromuscular disruption weapons), beanbag shotguns, pepper-ball guns and spray, expandable batons, and ballistic shields. Only CIT members are issued Tasers, while specific individual officers carry beanbag shotguns. Each of the six district stations has two ballistic shields, and all other less-than-lethal weapons are standard issue.

The standardization of tactics affords officers the opportunity to prepare for a likely scenario, practice a tactic to proficiency, and develop the critical aspect of coordination. In a dynamic and stressful situation, they often do not have time to attempt to design, communicate, and employ a tactical plan. Having flexible preplanned basic tactics helps to promote efficient and controlled operations. Officers who lose control of a tactical situation may feel that they must overreact to regain control. This introduces dangerous and unpredictable elements into an already serious situation.

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Standardization explains why all patrol officers practice high-risk felony vehicle stops the same way, why all plain-clothes officers rehearse vehicle takedowns in the same manner, and why SWAT members execute tactical entries repeatedly. Consistency of training and trust allows officers to perform their individual roles and rely on their teammates to do the same, thus achieving a synergistic effect.

The basic deployment of the less-than-lethal plan is based on a triangle, using three officers. The plan, however, is flexible enough for two to initiate. The primary "contact" CIT officer (9) assumes a position to engage the individual and is responsible for all commands, communication with the person, and the deployment of less-than-lethal force. The assisting cover officers stand a few feet to the rear on both sides of the contact officer, forming a triangle. At the contact officer's direction, they are responsible for going hands on and effecting an arrest, including deploying deadly force if necessary. This role delineation provides a clear understanding of who does what, avoids confusion during the heat of the moment, and streamlines the command and control process, thereby replacing the discretion of multiple officers with the discretion of one officer who manages the encounter.

The CIT Officer Component

Upon completion of the 40-hour block of instruction, CIT members receive a badge-shaped insignia to wear above their name tag. Agencies that participate in the CIT program advise consumers (10) who come into contact with them that officers wearing the insignia have received special training in various de-escalation and interview techniques and know of various health services that can help consumers in crisis. CIT members, appropriately identified in the CAD (computer-aided dispatch), are dispatched as the primary officer on all calls involving people suspected of having a mental illness. These range from attempted suicides to disturbance calls. Once on the scene of a critical incident, the CIT officer will determine the following:

* Does the person appear to have a mental illness?

* Does the person need an emergency evaluation? At this point, the officer also assesses the dangerousness of the situation and may apply the appropriate de-escalation techniques.

* Should the person be criminally charged or diverted to a mental health agency? This applies only in minor misdemeanor cases.

* Does the person require immediate medical or mental health attention? If not, where can the individual seek the appropriate help? In some cases, the families need referrals to an agency or organization for help.

The Montgomery County Department of Health and Human Services has established a Mobile Crisis Team comprised of mental health professionals who operate from 8 a.m. to midnight, 7 days a week. If a CIT officer responds to the scene of a person in obvious crisis but the person does not exhibit the behavior the officer needs to draft an emergency evaluation petition, the Mobile Crisis Team responds to assist. Because mental health professionals make up the team, they have a greater ability to draft an emergency evaluation petition.

If a CIT officer is on the scene of a critical incident that requires the use of less-than-lethal force, the officer determines when and what force to employ. If the incident evolves into a barricade situation, the negotiators from the Emergency Response Team (many are CIT trained) respond and take control of the scene. However, CIT officers resolve a majority of the calls by using their interview and de-escalation skills. By far, the greatest tool that the CIT officer brings to the scene is empathy for the person in crisis.

The CIT Coordinator Component

From the inception of the program, an officer has served full time as the department's CIT coordinator to establish and develop relationships with the partner agencies; organize the basic CIT training course on a bimonthly basis, the training courses for the less-than-lethal weaponry, and the advanced training seminars; attend quarterly meetings with the police chief; meet monthly with the district CIT coordinators; and participate in various meetings within the mental health community. The coordinator also tracks all incidents involving CIT officers and collects data on CIT incidents. For statistical purposes, all CIT members must complete a 1-page report whenever they handle an incident.

In addition to the CIT coordinator, each of the six police district stations has an officer assigned as a district CIT coordinator, a voluntary position performed along with regular patrol responsibilities. The district coordinators assist the department coordinator by recruiting officers to become CIT certified; tracking the various incidents involving CIT members; briefing other officers on critical incidents at roll calls; assisting CIT members with their cases; helping with the basic, advanced, and less-than-lethal training courses; participating in monthly meetings with the department CIT coordinator; attending quarterly briefing sessions with the chief of police; and filling in for the department coordinator when necessary.

LEGAL CONSIDERATIONS

For many law enforcement agencies, policy change often comes only on the heels of a lawsuit or an embarrassing major incident. (11) However, instead of waiting for that fatal police shooting or the federal investigation for excessive force, law enforcement leaders should go on the offensive, be proactive, and implement policy that will help mitigate a plaintiff's civil claim.

Prior to committing acts of violence, many subjects write letters, make telephone calls, and use other methods to communicate with those in law enforcement. (12) Officers must learn to recognize that this type of behavior may indicate a person in crisis who requires immediate intervention. They must remember that mental illness is a disease, one that affects 1 out of 5 Americans. (13) Identification of these behaviors and early intervention may help avoid a violent encounter. Training law enforcement officers in de-escalation techniques that involve both verbal skills and less-than-lethal tactics may represent the single factor for prevailing in a wrongful death or excessive force civil lawsuit. (4)

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Two of the most common civil suits brought against law enforcement leaders are failure to properly supervise and failure to provide adequate training. (15) Generally filed in federal court, these suits charge that a department's failure to properly supervise and train led to a violation of a person's civil rights under Title 42, Section 1983, U.S. Code (commonly referred to as "section 1983"). The standard of proof for such a claim is so high that the U.S. Supreme Court requires a plaintiff to prove that the defendant showed "deliberate indifference."

In Monell v. New York City Department of Social Services, (16) the Supreme Court stated, "A city is not liable under a section 1983 claim unless a municipal 'policy' or 'custom' is the moving force behind the constitutional violation. Only where a failure to train reflects a 'deliberate' or 'conscious' choice by the municipality can the failure be properly thought of as an actionable city policy."

The Supreme Court revisited the issue in City of Canton v. Harris. (17) Here, the court held that liability could be attached against a municipality where the municipality's failure to train reflects a deliberate indifference to the constitutional rights of its citizens. The court further stated that where the need for additional training is "so obvious" and the failure to provide the additional training is "so likely" to result in a constitutional violation, deliberate indifference may be able to be shown. (18)

The challenge for law enforcement leaders is making sure that their departments are not vulnerable to claims of deliberate indifference, especially when dealing with individuals who are mentally ill. Courts may find that the mere fact that a department failed to train its officers to recognize and handle people with mental illness is cause enough to show deliberate indifference. In Olsen v. Layton Hills Mall, (19) the U.S. Court of Appeals for the Tenth Circuit held that a municipality could be sued for failing to train its officers to recognize signs of the psychological disorder, obsessive-compulsive disorder.

The facts in the Olsen case are a common occurrence. The plaintiff, who had obsessive-compulsive disorder, complained to the arresting officer and jailers that he was having a panic attack. The officers ignored his complaints and denied him his medication. The plaintiff filed a claim charging that the officers violated his Eighth Amendment rights because they failed to recognize his medical needs. (20) The appellate court reversed the lower court's granting of summary judgment to the defendant and ruled that a finding of deliberate indifference in violation of the Eighth Amendment has two prongs: an objective prong and a subjective prong. The objective prong is met if the medical need is "sufficiently serious"; the subjective prong requires that the defendant knows of and disregards an excessive risk to the plaintiff's health or safety.

Objectively, the court ruled that obsessive-compulsive disorder may be both grave enough and prevalent enough to qualify as sufficiently serious. Subjectively, the court held that the jury must resolve the issue of whether the defendant knew of the plaintiff's condition and, thus, could infer that a substantial risk of serious harm existed. (21) The court held that although the plaintiff had not successfully linked the officer's possible constitutional violation to a custom or policy of the city that employed him, (22) the plaintiff alleged facts that could establish that the county manifested deliberate indifference by failing to train its jailers to recognize individuals with obsessive-compulsive disorder and to handle them appropriately. (23)

Unlike suits alleging harassing or discriminatory practices, a person alleging failure to properly supervise or provide adequate training does not have to show past practices or a course of conduct to raise the claim. Courts in some jurisdictions have held that a single incident can be enough to raise the claim of improper supervision and inadequate training. In the case Atchinson v. The District of Columbia, (24) the U.S. Court of Appeals for the D.C. Circuit held that a single incident of the use of deadly force was adequate to support a complaint of inadequate training and supervision. (25)

Numerous advocacy groups throughout the nation demand that their local law enforcement agencies follow the lead and train officers in specialized methods of dealing with individuals who are mentally ill. What once was considered an area of special training may soon become a common practice, thereby raising the legal standard to which agencies are held. Law enforcement leaders not offering similar training may find themselves at a disadvantage. Those who do offer it will find that the cost to train their personnel to deal with people who have mental illness proves less expensive than a civil action. (26)

CONCLUSION

Sadly, statistics show that people with mental illness sometimes become violent and harm others, even law enforcement officers trying to help them. Therefore, law enforcement agencies must find ways to safeguard their officers while, at the same time, protecting such individuals from themselves and the disorders that can cause them to suffer greatly.

The Montgomery County, Maryland, Police Department established a program to help it peacefully resolve potentially violent encounters with people who are mentally ill. By partnering with local and state criminal justice and mental health organizations, its Crisis Intervention Team provides officers the tools and techniques to safely and effectively deescalate critical incidents involving people with mental illness.

For questions about the Montgomery County CIT program, call the CIT coordinator at 240-773-5057.

Endnotes

(1) M. Grunwald and S.G. Boodman, "Weston Case Fell Through Cracks: Violence by Mental Patients Hard to Predict, Experts Say," The Washington Post, July 28, 1998, sec. A, p.1.

(2) K. Mohandie and J. Duffy, "Understanding Subjects with Paranoid Schizophrenia," FBI Law Enforcement Bulletin, December 1999, 8-16.

(3) U.S. Department of Justice, Federal Bureau of Investigation, Law Enforcement Officers Killed and Assaulted, 2001 (Washington, DC, 2002), 33.

(4) Ibid., 93.

(5) U.S. Department of Health and Human Services, Mental Health: A Report of the Surgeon General (Rockville, MD, 1999); retrieved on October 9, 2003, from http://www.surgeongeneral.gov/library/mentalhealth/home.html.

(6) Police Executive Research Forum, The Police Response to People with Mental Illness, Module II-21, 1997.

(7) Ibid.

(8) The Memphis, Tennessee, Police Department's model couples intense crisis intervention training for officers with a partnership between law enforcement agencies, mental health providers and advocates, and individuals with mental illness. For an example of another agency's program, see Michael Klein, "Law Enforcement's Response to People with Mental Illness," FBI Law Enforcement Bulletin, February 2002, 11-14.

(9) The contact officer does not necessarily have to be a CIT officer.

(10) The National Alliance of the Mentally Ill has advanced the term consumers as the proper one to use when identifying a person with mental illness.

(11) Susan Rogers, "Police, Consumers and Families Join Forces to Improve Crisis Response," The Key (Fall 2000).

(12) Supra note 2, 11.

(13) Supra note 5.

(14) Although most states and the federal government provide qualified immunity from lawsuits for law enforcement officers if their actions were within the scope of their duties and without malicious intent, situations can occur where immunity will be denied. For example, officers who unknowingly violate a clear constitutional standard will be denied qualified immunity even if they acted without malice and in the belief that their actions were legal.

(15) R. Hill and J. Logan, "Civil Liability and Mental Illness: A Proactive Model to Mitigate Claims," The Police Chief, June 2001, 31.

(16) 436 U.S. 658, 694 (1978).

(17) 489 U.S. 378 (1989).

(18) Supra note 15, 30.

(19) 10th Cir., No. 01-4130 (12/11/02).

(20) The Eighth Amendment states, in part, "nor cruel and unusual punishment inflicted."

(21) "Lack of Training on Mental Disorder May Lead to Liability," The Law Officers' Bulletin, January 16, 2003, 16.

(22) Monell v. New York City Department of Social Services, 436 U.S. 658 (1978).

(23) Supra note 21.

(24) 73 F.3d 418 (D.C. Cir. 1996).

(25) Supra note 15, 31.

(26) Supra note 15, 31.
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Author:Ellis, Kathryn
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Date:Jul 1, 2004
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