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CIT Goals Objectives Overview Jan 2023.pptx
- 1. Copyright © 2023 Vaya Health. All rights reserved. Crisis Intervention Team (CIT) Training Criminal Justice and CIT Overview
- 2. Copyright © 2023 Vaya Health. All rights reserved. 2 Objectives Identify and understand: • The background problem • Crisis Intervention Team (CIT) training definition • The purpose of CIT • The goals of CIT • Criminal Justice Approaches • Core elements of the Memphis Model • The benefits of CIT • CIT partnerships, collaborations, and characteristics
- 3. Copyright © 2023 Vaya Health. All rights reserved. 3
- 4. Copyright © 2023 Vaya Health. All rights reserved. 4 The Background Problem People with mental health disorders behind bars (2012): • 479,000 in jails • 705,600 in state prisons • 78,800 in federal prisons Fatal police contacts in the United States (2017): • 246 People with mental health disorders who are homeless in the United States (2010): • 216,000
- 5. Copyright © 2023 Vaya Health. All rights reserved. 5 More Important Numbers • About 25,000 people with serious mental health conditions enter North Carolina jails every year. • About 72% of people in jail who have a mental health condition also have a substance use disorder. • Of the 17,366 North Carolina inmates screened during fiscal year 2016-2017 for substance use, 71% needed long-term substance use treatment. The average cost to treat substance use in jail is about $17 a day.
- 6. Copyright © 2023 Vaya Health. All rights reserved. 6 United States History Deinstitutionalization Today’s broken mental health system
- 7. Copyright © 2023 Vaya Health. All rights reserved. 7 What is CIT? CIT programs are local initiatives designed to improve the way first responders and the community respond to people experiencing mental health crises. CIT programs are built on partnerships among law enforcement, EMS, fire departments, the National Alliance on Mental Illness (NAMI), mental health provider agencies, and individuals and families affected by mental health disorders.
- 8. Copyright © 2023 Vaya Health. All rights reserved. 8 Why CIT? • Some people with mental health disorders do not receive treatment, and others discontinue their medications. • People with untreated mental health disorders may be agitated, experience psychosis, or feel suicidal. • When a crisis occurs, the first point of contact is often law enforcement.
- 9. Copyright © 2023 Vaya Health. All rights reserved. 9 CIT is designed to increase the safety of officers, first responders, and people in crisis. CIT can connect individuals to appropriate services and supports for behavioral health needs. CIT helps strengthen ties with the community and reduce arrests.
- 10. Copyright © 2023 Vaya Health. All rights reserved. 10 CIT is about: • System transformation • Partnerships/relationships • Community engagement • Advocacy • Specialized training • Leadership • You
- 11. Copyright © 2023 Vaya Health. All rights reserved. 11 Goals of CIT • Improve safety: • Community • Individuals with lived experience • Law enforcement • Provide law enforcement with tools to properly handle behavioral health and intellectual/developmental disability (I/DD) crises • Ensure rapid and effective crisis response • Make effective use of time and resources • Make behavioral health and I/DD systems understandable and accessible • Reduce stigma surrounding behavioral health and I/DD issues • Keep individuals with disabilities from the criminal and juvenile justice systems, when it is appropriate to do so
- 12. Copyright © 2023 Vaya Health. All rights reserved. 12 CIT Curriculum • Information about mental health disorders • Community agency and program visits • De-escalation skills • Veterans and other special topics • Scenario-based practice • Community resources
- 13. Copyright © 2023 Vaya Health. All rights reserved. 13 Criminal Justice Approaches: Sequential Intercept Model (SIM)
- 14. Copyright © 2023 Vaya Health. All rights reserved. 14 Memphis Model Situation: In 1987, Memphis police shot and killed a man with a mental health condition In response, the Memphis Police Department and local NAMI affiliate developed the CIT model
- 15. Copyright © 2023 Vaya Health. All rights reserved. 15 Memphis Model Core Elements • Partnerships – Law enforcement, advocates, mental health organizations • Community ownership – Planning, implementation, networking • Policies and procedures Operational Elements • CIT – Officer, dispatcher, coordinator • Curriculum – CIT training • Mental health receiving facility – Emergency services Sustaining Elements • Evaluation and research • In-service training • Recognition and honors • Outreach – Developing CIT in other communities
- 16. Copyright © 2023 Vaya Health. All rights reserved. 16 Teaches first responders to recognize a potential behavioral health crisis Emphasizes humane responses to people in crisis Provides first responders with tools to help them help others and improve personal and public safety Enables first responders to carry out their job functions CIT and First Responder Culture
- 17. Copyright © 2023 Vaya Health. All rights reserved. 17 Benefits of CIT • Decreases the number of people with mental health disorders in detention facilities • Decreases injuries for first responders and people in a mental health crisis • Decreases use of force during crisis events • Helps CIT first responders become advocates and resources • Improves collaborations with mental health and advocacy resources • Saves time and money • Provides alternatives to arrest • Increases officer and department recognition
- 18. Copyright © 2023 Vaya Health. All rights reserved. 18 Benefits of CIT for Families and Members/Recipients Decreases use of force on members/recipients Decreases number of member/recipient injuries Improves access to treatment Improves collaboration with police and mental health resources Partners in advocacy and educational efforts Helps people with mental health disorders and family members be more willing to call 911 for assistance
- 19. Copyright © 2023 Vaya Health. All rights reserved. 19 Collaboration Systems and Infrastructure of Services Relationships Advocacy Empathy NC Law Enforcement Agencies NC Emergency Management System Agencies NC Fire Departments NAMI NC Colleges NC Providers NC State Leadership Justice Systems
- 20. Copyright © 2023 Vaya Health. All rights reserved. 20 CIT Program: Steering Committee and CIT Coordinators Steering Committee Members: • Community partners and stakeholders Responsibilities: • Lead community coordination • Evaluate community system and resources • Coordinate CIT training and outreach • Seek funding CIT Coordinators Members: • Law enforcement and mental health organizations and/or advocates Responsibilities: • Ensure integrity of the CIT program • Manage day-to-day aspects of the program • Keep CIT partners together
- 21. Copyright © 2023 Vaya Health. All rights reserved. 21 CIT Success CIT is about YOU! YOU are the key to CIT success! • How can you improve your problem-solving skills? • How can you cultivate community partnerships? • How can you improve your communication skills? • What can you do to reduce stigma? • How can you lead by example?
- 22. Copyright © 2023 Vaya Health. All rights reserved. 22 CIT in North Carolina • More than 11,000 officers and more than 2,400 first responders and telecommunicators in North Carolina are certified in CIT. • More than 1,400 law enforcement officers, first responders, and other professionals in North Carolina have completed Vaya Health’s CIT program.
- 23. Copyright © 2023 Vaya Health. All rights reserved. 23
- 24. Copyright © 2023 Vaya Health. All rights reserved. 24
- 25. Copyright © 2023 Vaya Health. All rights reserved. Thank You Thank you for being a member of the Crisis Intervention Team in North Carolina!
Editor's Notes
- Trainer Note: Lead a brief discussion about the facts on the slide, using the below information as reference material. Make note that these statistics involve people with mental illness, those with I/DD are at times inappropriately incarcerated and have been killed by police. Content Note: Understanding how we got where we are is challenging, but it informs how we move forward. Here are some facts to consider, by way of outlining these problems as they currently exist. In a 2017 special report (based on data from a 2011-2012 study), the Bureau of Justice Statistics (BJS) estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons and 479,000 in local jails. Source: https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf According to an ongoing Washington Post database, police shot and killed 246 people with signs of mental illness in 2017. Source: https://www.washingtonpost.com/graphics/national/police-shootings-2017 According to the Ruderman Foundation, up to half of people killed by police are people with disabilities. People with disabilities who have other marginalized identities are more likely to be killed by law enforcement. Source:https://rudermanfoundation.org/wp-content/uploads/2017/08/MediaStudyPoliceDisability_final-final.pdf People with untreated serious mental illness comprise approximately one-third of the total homeless population and an even higher percentage among homeless women and among individuals who are chronically homeless. A 2010 HUD survey of the homeless reported that they numbered 649,917. Assuming one-third have a serious mental illness, they would total approximately 216,000 individuals. Source:https://www.treatmentadvocacycenter.org/storage/documents/backgrounders/smi-and-homelessness.pdf Ask participants if they find the information on the slide surprising. Also, ask how they believe they can affect those statistics
- Trainer Note: Instructors should be prepared to introduce the information on the slide, using the material below as a reference, then answer any questions participants have. Emphasize that most communities did not readily accept the influx of redirection of people with mental illness from state hospitals to the communities. The most readily available facility was a jail, and law enforcement became the go-to response for mental health crises in the community. CIT is a program that provides the foundation necessary to promote community and statewide solutions to assist individuals with mental illness and/or addictions be diverted from the criminal justice system and into treatment, when appropriate. The CIT Program reduces both stigma and the need for further involvement with the criminal justice system. CIT provides a platform for effective problem solving regarding the interaction between the criminal justice and mental health care system and creates the context for sustainable change. Source: http://www.citinternational.org/Learn-About-CIT Content Note: Deinstitutionalization: The history of deinstitutionalization falls into several stages as policies and objectives have changed over time. The early focus was on moving individuals out of state public mental hospitals: from 1955 to 1980, the resident population in those facilities fell from 559,000 to 154,000. Only later was there a focus on improving and expanding the range of services and supports for those now in the community, in recognition that necessary supports and medical treatment were insufficient to sustain community residence. In the 1990s, institutions began to close in significant numbers and, there was a greater emphasis on rights that secured community integration – such as access to housing and jobs. Source: Korangi, Chris. 2007. “Learning from History: Deinstitutionalization of People with Mental Illness as Precursor to Long Term Care Reform”: https://www.kff.org/wp-content/uploads/2013/01/7684.pdf
- Often don’t get treatment – A U.S. Justice Dept study found 60% of people with SMI in jail don’t get treatment. This also leads to greater deterioration of mental status. Serve longer in jail and prison – Spend two to five times longer in jail and average 15 months more in prison. Have more difficulty coping – Experience more fights, infractions, and sanctions while incarcerated, resulting in longer sentences and more jail or prison time. More likely to commit suicide – Half of all inmate suicides are inmates with SMI. Are more vulnerable – To being exploited or manipulated by other inmates.
- Trainer Note: Consider this an opportunity to have a brief explanation of the work that may have taken place prior to the CIT training about the crisis response system. Many localities conduct Sequential Intercept Mapping to identify strength and gaps in the crisis response system with input from law enforcement. Effective CIT programs are continually working on improving the overall system. If time allows, instructors should briefly explain what the sequential intercept model also examines other parts of the criminal justice system to find gaps and opportunities to increase diversion from the criminal justice system for those with behavioral health disorders and/or I/DD. (Examples of some diversion approaches include Mental Health Court, Drug Courts, jail screening and programming, reentry, etc.). This does not need to be covered in-depth. Content Note: The Sequential Intercept Model (SIM) helps identify strengths and weaknesses in communities, what role law enforcement plays, and how communities can improve the services they offer. This model provides a framework on how a person in crisis may intersect with the criminal justice system and how they move through it. It provides opportunities to develop intercept points for diversion and identify needed resources for transforming the community crisis response system and treatment system. Crisis Intervention Teams is a proactive police response model for vulnerable individuals in crisis through a unique method of diverting individuals from the criminal justice system. Note the approaches in intercepts 0 and 1 where first responders encounter individuals experiencing a mental health crisis. Intercept 0 Mobile crisis outreach teams and co-responders. Behavioral health practitioners who can respond to people experiencing a behavioral health crisis or co-respond with police to a police encounter. Emergency Department diversion. Emergency department (ED) diversion can consist of a triage service, embedded mobile crisis, or a peer specialist who provides support to people in crisis. Police-friendly crisis services. Police officers can bring people in crisis to locations other than jail or the ED, such as stabilization units, walk-in services, or respite. Police-friendly crisis services. Police officers can bring people in crisis to locations other than jail or the ED, such as stabilization units, walk-in services, or respite. Intercept 1 Dispatcher training. Dispatchers can identify behavioral health crises and pass that information along so that Crisis Intervention Team officers can respond to the call. Specialized police responses. Police officers can learn how to interact safely with individuals experiencing a behavioral health and/or I/DD crisis and build partnerships between law enforcement and the community for jail diversion opportunities and mental health system changes. Crisis Intervention Team (CIT) is one model. Intervening with frequent users of the crisis system and providing follow-up after the crisis. Police officers, crisis services, and hospitals can reduce super-utilizers of 911 and ED services through specialized responses.
- Trainer Note: It may be helpful to talk about the CIT steering groups and/or CIT coordinators already in place in this jurisdiction or bring up examples from neighboring jurisdictions. This slide does not have to be covered in-depth; instead, the steering committee should be mentioned to inform participants what organizations and agencies are part of the steering committee and what role their agency plays. This slide illustrates the importance of community partnerships and community ownership of CIT. Reference the below information as needed. Content Note: A CIT Steering Committee helps to formalize the work of those dedicated community partners and, it creates a structure for committing to CIT. The committee should initially include the core community partners--law enforcement, mental health providers, and advocates--as well as any interested community leaders (such as judges or mayors) who can become champions for CIT. Those core partners must commit to working together and share a common vision before recruiting a broad stakeholder group. CIT Coordinators are individuals from law enforcement, mental health and advocacy who take the lead with their organizations to help develop, implement, oversee and lead the CIT program. To successfully implement a Crisis Intervention Team (CIT) program, a steering committee comprised of individuals who represent CIT should be formed. This steering committee should reflect your community and those groups who have a vested interest in the development of a CIT program. A steering committee may include members of local government, judiciary, law enforcement, mental health, including VA Medical Center or VA Outpatient facility, corrections, and advocacy groups, to name only a few.