by Laura Usher, NAMI CIT Program Manager

For first responders, dealing with a mental health crisis is often frustrating and unfamiliar territory. Is it an emotional crisis, a medical problem or a substance abuse issue? Is the situation safe? Will I be able to talk the person down from the height of a crisis? Where is the best place to take the person to get medical help? Ensuring everyone’s health and safety is usually the biggest concern of any first responder, but a mental health crisis can be unpredictable and unnerving.

The good news is that excellent training and partnership with local mental health services can help make a crisis manageable, keep everyone safe and help people in crisis to mental health care. Crisis intervention teams (CIT) are designed to bring together local law enforcement, first responders, mental health provider and NAMI Affiliates to provide a unique response.

The first CIT program was started in Memphis, TN after police tragically shot a man in the midst of a mental health crisis. Knowing that there had to be a better way, the community pulled together to train police officers on identifying a mental health crisis and safely de-escalate the situation. In the process, they learned that personal connections between officers, mental health workers, individuals with mental illness and their families helped to change the community.

A crisis is hard on individuals and their families, and the mental health professionals and first responders that they turn to for help. Understanding this has helped Memphis develop some good solutions – a division of labor so everyone knows their role; a dedicated mental health triage center so everyone knows exactly where to get mental health services and a more open and trusting relationship between individuals, families, police and mental health professionals. People are more likely to ask for help, and when they do ask for help, they are more likely to get it, rather than face arrest or injury.

CIT Is Not Just for Law Enforcement

Today, there are CIT programs in 2800 communities around the country. As CIT programs have spread, they have expanded to include a variety of partners and professionals, including firefighters and EMS, who regularly respond to mental health crisis calls. Other communities have trained hospital security, campus police, VA police, airport police, correctional officers, and in at least one case, fish and game wardens.

All of these professionals need to be able to safely de-escalate a crisis and know how to coordinate with law enforcement and mental health services. Every community is different, so the agencies and responders who need to be involved will be different. You may want to connect with the CIT program nearest to you and find out whether they have opportunities for training or partnership.

CIT Training and Partnerships

CIT training usually involves a 40-hour class delivered by local mental health providers, law enforcement officers, individuals living with mental illness and family members. This mix is important to getting a full picture of the issues surrounding mental health crises and introducing students to the local people they should contact if they need assistance or advice. Some highlights of the class include:

   •   The signs and symptoms of mental health conditions, including schizophrenia, bipolar disorder, depressions, suicide, PTSD, substance abuse conditions,
   •   Formal presentation and group conversations with individuals living with mental illness who are doing well,
   •   The family perspective on a mental health crisis,
   •   Introduction to local advocacy organizations like NAMI Affiliates and the educational programs and services they offer,
   •   Mental health resources in the local community and how to connect people with these resources,
   •   Intensive scenario-based training on verbal de-escalation of mental health crisis situations,
   •   Officer safety,
   •   Interacting with children and youth in crisis or other special populations, and
   •   Legal rights of people with mental illness, the criteria for emergency psychiatric evaluation and civil commitment.

The training is really tailored to local needs and resources. Many CIT programs will do separate training for first responders who are not law enforcement officers, to address their specific needs and leave out any topics (like legal issues) that may not be relevant to that professional.

CIT training is just one part of the CIT program. If you or your agency participates in the training, you should also find out how you can coordinate better with mental health service providers and law enforcement in your community. Many calls for service may require police, fire, EMS and other first responders to work together in mental health crisis; it’s best to have a plan in place in advance to know your role. You can also learn about other programs that may be helpful, such as homeless services, substance abuse treatment or veterans’ services. The more that everyone knows how to connect people in crisis to get the services they need, the better off the whole community. First responders can also offer to spread the word about CIT or help with future training.

Resources are Scarce in Rural Areas

Nationwide, the mental health system is underfunded and difficult to navigate. Many individuals and families do not know where to get help when a mental health issue emerges. People in rural areas have a particularly difficult time getting mental health care. In many states, it may be a several hour drive to the nearest mental health clinic or psychiatric hospital. Many people also have a hard time with getting transportation to their appointments or being able to afford time off work to go to appointments.

These problems getting access to treatment can actually make it more likely that people will go into a crisis. The same lack of resources can also mean that police and other first responders in rural areas don’t have many resources to respond. The lack of resources makes it even more vital that local agencies work together and make a plan for responding in a crisis. CIT programs are a great way to build that partnership and plan together as a community.

NAMI (the National Alliance on Mental Illness) is the nation’s largest grassroots organization of individuals and families directly affected by mental illness. For more information about CIT, visit http://www.nami.org/cit or contact Laura at laurau@nami.org.