How Police Officers Are (or Aren’t) Trained in Mental Health

By Megan Pauly
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A Capitol Hill police officer stands guard in Washington, D.C., Friday, a day after a woman was shot to death outside the Capitol. (Evan Vucci/AP)

The recent Capitol Hill shooting of an unarmed woman by police officers, and the uncertainty surrounding her mental state at the time she drove her car into a White House barricade, is a stark reminder of the uncomfortable interplay between mental illness and law enforcement in times of crisis.

Without the appropriate amount of mental health training for police, experts say, rash stigmatization and misinterpretation of the intentions of the mentally ill can cause vital errors and ultimately make the difference between life and death.

The National Alliance on Mental Illness (NAMI) strives to increase awareness and understanding of the mentally ill through its partnership with the University of Memphis Crisis Intervention Training Program, but within the law enforcement population, much is still to be done.

Crisis Intervention Training (CIT)—with a 40-hour curriculum—is the most comprehensive police officer mental health training program in the country. According to Laura Usher, CIT program manager at NAMI headquarters in Arlington, Virginia, there are crisis intervention training programs in 45 states as well as the District of Columbia. (States without programs are Delaware, West Virginia, Alabama, Arkansas, and Rhode Island.)

While there are multiple CIT programs within some counties, many states are barely on the map in terms of the number of counties within each state that have programs. Most states only have CIT programs in one or two counties.

In the D.C. area, the Metropolitan Police Department, the United States Capitol Police Department, and the Georgetown Law School Campus Police Department have partnerships with NAMI. The crisis training programs are not mandatory, though, says NAMI D.C. executive director Sophie Clark.

David Shapiro, training manager for the D.C. Department of Behavioral Health—which merged with the Department of Mental Health at the beginning of this month—said that all incoming police recruits in the D.C. area receive some degree of mental health training but did not provide information about number of hours required or number of officers trained.

According to Shennell Antrobus, United States Capitol Police Department (USCP) public information officer, all of the department's officers and recruits receive mental health training. He did not provide information about the number of training hours required or number of officers on the force who are trained. He could not comment on anything related to the recent Capitol crisis, as an investigation is ongoing.

In a statement, Antrobus said the Federal Law Enforcement Training Center’s Behavioral Science Division partnered with the USCP in 2009 to create a training video providing instructions of how officers should appropriately handle mental health issues.

Usher stressed that the crisis intervention training program isn’t strictly a NAMI program but more of a partnership between local agencies. She said that it’s up to any given community to decide how it wants its law enforcement, mental heath and advocacy agencies to work together.

“For a good CIT program to work, all of these partners need to work together,” Usher said.

For example, law enforcement agencies need to have the authority to drop someone off at a psychiatric outpatient facility if necessary. However, the lack of mental health resources across the U.S. ranges from a deficiency of crisis assessment centers to a shortage of service providers like social workers and psychiatrists, Usher said.

“The default hospital has become the emergency room,” Usher said, adding that most emergency rooms are not equipped to effectively handle psychiatric issues.

“In the meantime, [mentally ill patients] are really suffering,” Usher said.

While money isn’t the deciding factor in the success of a mental health program, it is an important factor, especially within municipal police departments. Usher suggested that the scarcity of monetary and human resources has lead to the drought of mental health training hours officers receive.

“Most law enforcement agencies can’t afford to train everyone,” Usher said. “They’d have to pay someone else overtime, and that can be a big expense, especially if you’re a small office.”

Usher said that many police departments prefer to train only a few specialized officers to deal with crisis issues, rather than making mental health training mandatory.

 “[The department] would be over-resourced for a certain small number of incidents,” Usher said. “Not everyone is well-skilled for a certain task. What most communities want to do is develop a group of officers who are highly trained, and they’re the ones who are called in a crisis.”

But what happens if the first responder isn’t properly trained to handle the situation?

“If the officer knows this is out of his scope, it’s generally best for them to step back, call for backup and not engage beyond their skills,” Usher said.

In his article “Art of De-Escalation,” Michael Woody, president of CIT International, said that a lack of police personnel and a lack of funds is no excuse for not doing something when it comes to educating and training officers on mental health issues.

Woody chose to do something himself during his career with the Akron, Ohio police department after he encountered a 27-year-old mentally ill individual who threatened Woody’s life and ultimately committed suicide.

The incident never left Woody and prompted him to challenge the five mandatory hours of mental health training officers were required to obtain in the state of Ohio. He was ultimately able to convince the state attorney general to increase the five required hours to 16.

Woody’s interest in mental health didn’t stop there. He researched the number of hours of mental health training required of officers in different states, ultimately revealing a wide range of program requirements.

What he found was a sliding scale of 0-40 mandatory hours of training. Many states have no mandatory training for an issue that accounts for 10 percent of police calls, Woody said.

“Alaska had the highest number of overall training hours, but when it came to mental health there was nothing we could find,” Woody said. “But in Florida, in the academy, the officers received 40 hours of mental health training.”

Even some states, like Hawaii, that have a registered CIT program require zero mental health training hours for officers.

Of the 37 states that responded to Woody’s inquiries, the majority require 8 hours or less.

The issue of force, due to the Capitol Hill shooting, has been called into question.

“Looking at the incident at the Capitol it’s hard to Monday-morning quarterback it,” Usher said. “It’s hard to look at what could have been done differently… I don’t know that anyone knows exactly the circumstances.”

Whether or not Miriam Carey was receiving proper mental health care prior to the incident—and whether earlier intervention would have been possible—is also unknown at this point.

But Usher did say that since the CIT program’s introduction in 1988 by the University of Memphis, CIT-trained officers have been found less likely to use force when responding to mental health calls. Officer injuries have also dropped 80 percent across the board when responding to mental health calls, Usher said.

“I think that in terms of the program now, the challenge is making sure the mental health services are adequately funded to keep up with the interest the police department has in them,” said Dr. Randolph Dupont, who helped start the Memphis CIT program.

He said police departments are becoming more and more interested in the crisis intervention model, and that mental health agencies need to be able to provide the necessary response that reinforces what the officers want to do.

Dupont said that violence isn’t as big of an issue within the realm of mental illness as a lot of people might think.

“It would be unfair to those who have mental illness to characterize it as something that involves violence on a regular basis,” Dupont said, noting that it’s more likely that the mentally ill individual will be the victim of violence. “We still have a long way to go. We’d like to see a larger group be a part of the CIT program.”

Sophie Clark of NAMI D.C. agrees, but says NAMI D.C. has grown leaps and bounds since it was introduced a few years ago.

While Clark could not confirm exact numbers, she said that between 100 and 200 police officers in D.C. have received mental health training through the organization’s partnership with local police departments.

NAMI D.C.’s crisis intervention training consists of a one-week intensive program complete with a field practicum, allowing officers a glimpse of a day in the life of a stable mentally ill individual.

“We make it a realistic point to say that here’s a face of someone living with mental illness,” Clark said. “Instead of trying to restrain them like a criminal they can look at a situation from another perspective.”

Clark said the organization’s goal is to provide training that helps officers to intervene in a way that is helpful and more sensitive. She hopes all officers will eventually receive the training.

Clark also said that she has gotten positive feedback from the community about an increase in mental health awareness.

 “You didn’t always hear those stories before,” Clark said. “Before, the officer just didn’t know.”

This article available online at:

http://www.theatlantic.com/health/archive/2013/10/how-police-officers-are-or-aren-t-trained-in-mental-health/280485/