Law Enforcement Essential Elements - Bureau of Justice Assistance

Improving Responses toPeople with Mental Illnesses

The Essential Elements of aSpecialized Law Enforcement–Based Program

Improving Responses toPeople with Mental IllnessesThe Essential Elements of aSpecialized Law Enforcement–Based Program

A report prepared by theCouncil of State Governments Justice Centerin partnership with the Police Executive Research Forum

for the

Bureau of JusticeAssistanceOffice of Justice ProgramsU.S. Department of Justice

Matt SchwarzfeldMelissa ReulandMartha Plotkin

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 JusticeAssistance (BJA),

Office of Justice Programs, U.S. Department of Justice. The opinions and findings in this document do not necessarily represent the

official position or policies of the U.S. Department of Justice, the members of the Council of State Governments, or the Police

Executive Research Forum.While every effort was made to reach consensus and represent advisory groupmembers’ and other

reviewers’ recommendations, individual opinions may differ from the statements made in the document.

The Bureau of JusticeAssistance 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.

This report follows and builds on the format and scope of The Essential Elements of a Mental Health Court, published in 2008with the

support of BJA (available at www.consensusproject.org/mhcp/essential.elements.pdf).A similar document describing the

elements of programs that bring together the corrections andmental health systems is in production at this writing and will be

made available at www.consensusproject.org.

Council of State Governments Justice Center, New York 10005

© 2008 by the Council of State Governments Justice Center

All rights reserved. Published 2008.

Cover design by Nancy Kapp & Company. Interior design by David Williams.

Contents

Acknowledgments v

Introduction vii

Ten Essential Elements

1 | Collaborative Planning and Implementation 1

2 | Program Design 2

3 | SpecializedTraining 3

4 | Call-Taker and Dispatcher Protocols 4

5 | Stabilization, Observation, and Disposition 5

6 | Transportation and Custodial Transfer 6

7 | Information Exchange and Confidentiality 7

8 | Treatment, Supports, and Services 8

9 | Organizational Support 9

10 | Program Evaluation and Sustainability 10

Conclusion 11

vThe Essential Elements of a Specialized Law Enforcement–Based Program

This report could not have been written without theleadership of the Bureau of Justice Assistance(BJA), Office of Justice Programs, U.S. Departmentof Justice, particularly from Domingo S. Herraiz,Director; A. Elizabeth Griffith, Deputy Director forPlanning; Robert Hendricks, former Policy Advisor;and Michael Guerriere, former Senior Policy Advi-sor for Mental Health and Substance Abuse. Addi-tional support was provided by Ruby Qazilbash,Senior Policy Advisor for Substance Abuse andMental Health, and Rebecca Rose, Policy Advisorfor Substance Abuse and Mental Health, during thefinal review and approval process.

Thanks are also due to members of a projectadvisory group, listed alphabetically below.1 A sub-set of the group (indicated by an asterisk) met inOctober 2005 and February 2006 to review earlierdrafts of this document, and the entire advisorygroup convened in September 2006 to provide theirinsights on a more recent version of the document.

• Mr. Stephen Baron, Director, District ofColumbia Department of Mental Health*

• Ms. Lesley Buchan, Program Director, Commu-nity Services Division, National Association ofCounties

• Major Sam Cochran, Crisis Intervention TeamCoordinator, Memphis (Tenn.) Police Department

• Dr. Steven M. Edwards, Senior Policy Advisorfor Law Enforcement, Bureau of Justice Assis-tance, U.S. Department of Justice

• Mr. Leon Evans, Executive Director, BexarCounty (Tex.) Jail Diversion Program

• Deputy Chief Del Fisher, Arlington (Tex.)Police Department

• Ms. Elaine Goodman, Former Coordinator,NAMI New Jersey Law Enforcement EducationProgram

• Mr. Robert Hendricks, Policy Advisor, Bureau ofJustice Assistance, U.S. Department of Justice*

• Mr. Ron Honberg, Director of Legal Affairs,NAMI*

• Ms. Linda Keys, Director of Clinical Services,Mental Health Center of Dane County (Wis.), Inc.

• Mr. Adam Kirkman, Project Associate, GAINSTAPA Center for Jail Diversion*

• Commander Barbara Lewis, Orange County(Fla.) Sheriff’s Office

• Chief Stefan LoBuglio, Montgomery County(Md.) Pre-Release and Re-Entry Services Division

• Officer Joan M. Logan, Crisis InterventionTeam Coordinator, Montgomery County (Md.)Police Department*

• Mr. Loel Meckel, Assistant Director, Divisionof Forensic Services, Connecticut Departmentof Mental Health and Addiction Services

• Ms. LaVerne Miller, Director, Howie the HarpPeer Advocacy Center

• Chief Richard Myers, Appleton (Wis.)Police Department

• Ms. Michele Saunders, Executive Director,Florida Partners in Crisis*

• Sergeant Rick Schnell, San Diego (Calif.)Police Department

• Ms. Bonnie Sultan, CIT Technical AssistanceCenter Coordinator, NAMI*

• Dr. Bruce Taylor, Director of Research,Police Executive Research Forum

• Representative John Tholl, Vice-Chair,Criminal Justice and Public Safety Committee,New Hampshire House of Representatives

Acknowledgments

1. Advisory Board members’ titles and agency affiliations reflect thepositions they held at the time of their involvement with the project.

vi Improving Responses to People with Mental Illnesses

• Lieutenant Richard Wall, Los Angeles (Calif.)Police Department

• Lieutenant Michael Woody (ret.), Law Enforce-ment Liaison, Ohio Criminal Justice CoordinatingCenter of Excellence*

A special thanks must be given to Council ofState Governments Justice Center Director MikeThompson and Health Systems and Services PolicyDirector Fred Osher for their insights in helpingshape the scope and direction of this publication. In

addition, the authors appreciate the ongoing supportthat the Police Executive Research Forum’s ExecutiveDirector, Chuck Wexler, has provided.

Finally, the authors wish to express their grati-tude to the nearly two hundred contributors whoprovided feedback in an August 2006 online Webforum. Far too many to name individually, thesepractitioners, policymakers, and advocates offeredinsights and suggestions that informed the authorsand can be seen throughout these pages.

viiThe Essential Elements of a Specialized Law Enforcement–Based Program

Law enforcement officers throughout the countryregularly respond to calls for service that involvepeople with mental illnesses—often withoutneeded supports, resources, or specialized train-ing.2 These encounters can have significant conse-quences for the officers, people with mentalillnesses and their loved ones, the community, andthe criminal justice system.3 Although theseencounters may constitute a relatively small num-ber of an agency’s total calls for service, they areamong the most complex and time-consuming callsofficers must address.4 At these scenes, front-lineofficers must stabilize a potentially volatile situa-tion, determine whether the person poses a dangerto him- or herself or others, and effect an appropri-ate disposition that may require a wide range ofcommunity supports.

In the interests of safety and justice, officerstypically take approximately 30 percent of peoplewith mental illnesses they encounter into custody—for transport to either an emergency room, a men-tal health facility, or jail.5 Officers resolve theremaining incidents informally, often only able to

provide a short-term solution to a person’s long-term needs. As a consequence, many law enforce-ment personnel respond to the same group ofpeople with mental illnesses and the same locationsrepeatedly, straining limited resources and foster-ing a collective sense of frustration at the inability toprevent future encounters.6

In response, jurisdictions across the country areexploring strategies to improve the outcomes ofthese encounters and to provide a compassionateresponse that prioritizes treatment over incarcera-tion when appropriate. These efforts took root in thelate 1980s, when the crisis intervention team (CIT)and law enforcement–mental health co-responsemodels, described in more detail below, firstemerged. Since that time, hundreds of communitieshave implemented these programs; some have repli-cated the models, and others have adapted featuresto meet their jurisdiction’s unique needs. Althoughthis number represents only a small fraction of allU.S. communities, there are many indications thatthe level of interest in criminal justice–mentalhealth collaborative initiatives is surging.7

Introduction

2. For the purposes of this document, “officer” refers to any lawenforcement personnel with direct contact with the community;this includes sheriffs’ deputies, state troopers, and other individualswith arrest powers.

3. The nation’s prisons and jails hold unprecedented numbers of peo-ple with mental illnesses—many of whom came into contact withlaw enforcement as a result of behaviors related to their illness. Forexample, in 1999 the Los Angeles County Jail and New York’s Rik-ers Island jail each held more people with mental illnesses thanany psychiatric inpatient facility in the United States. The mostrecent data from the Bureau of Justice Statistics, U.S. Departmentof Justice, reveals that more than half of all prison and jail inmatesreported that they had any one of a number of mental health symp-toms. E. Fuller Torrey, "Reinventing Mental Health Care," City Jour-nal 9 (1999):4; Doris J. James and Laura E. Glaze, Mental HealthProblems of Prison and Jail Inmates, U.S. Department of Justice,Bureau of Justice Statistics, NCJ-213600 (Washington, D.C.: Bureauof Justice Statistics, 2006).

4. Recent data indicate that behaviors that appear to be the result of amental illness are a factor in approximately 3–7 percent of all lawenforcement calls for service. See Martha W. Deane, Henry J. Stead-man, Randy Borum, Bonita M. Veysey, and Joseph P. Morrissey,“Emerging Partnerships between Mental Health and Law Enforce-ment,” Psychiatric Services 50 (1) (1999): 99–101; Lodestar, Los AngelesPolice Department Consent Decree Mental Illness Project Final Report(Los Angeles: Lodestar, 2002); Jennifer L.S. Teller, Mark R. Munetz,Karen M. Gil, and Christian Ritter, “Crisis Intervention Team Train-ing for Police Officers Responding to Mental Disturbance Calls,”

Psychiatric Services 57 (2006): 232–37; William Terrill and StephenMastrofski, “Situational and Officer-Based Determinants of PoliceCoercion,” Justice Quarterly 19 (2002): 215–48.

5. Linda Teplin, “Managing Disorder: Police Handling of the MentallyIll,” In Mental Health and the Criminal Justice System, ed. LindaTeplin. (Beverly Hills, CA: Sage Publications, 1984); Thomas M.Green, “Police as Frontline Mental Health Workers: The Decisionto Arrest or Refer to Mental Health Agencies,” International Journalof Law and Psychiatry 20 (1997): 469–86; Jennifer L.S. Teller, MarkR. Munetz, Karen M. Gil, and Christian Ritter, “Crisis InterventionTeam Training for Police Officers Responding to Mental Distur-bance Calls,” Psychiatric Services 57 (2006): 232–37.

6. Thomas M. Green, “Police as Frontline Mental Health Workers: TheDecision to Arrest or Refer to Mental Health Agencies,” Interna-tional Journal of Law and Psychiatry 20 (1997): 469–86; Gary Cordner,“People with Mental Illness,” Problem-Oriented Guides for Police Prob-lem-Specific Guides Series, 40, U.S. Department of Justice (Washing-ton, D.C.: Office of Community Oriented Policing Services, 2006).

7. Federal interest in criminal justice–mental health initiatives is per-haps best illustrated by the broad bipartisan support for the Men-tally Ill Offender Treatment and Crime Reduction Act of 2004(MIOTCRA) and its subsequent appropriations. MIOTCRA facili-tates collaboration among the criminal justice, juvenile justice,mental health treatment, and substance abuse systems in divertingindividuals to treatment when appropriate. Among its allowableuses, MIOTCRA funds can support law enforcement training. Formore information on MIOTCRA, see www.consensusproject.org/resources/government-affairs/fed-leg-MIOTCRA.

viii Improving Responses to People with Mental Illnesses

Specialized Law Enforcement–Based Response Programs

This document focuses on specialized law enforce-ment–based response programs that meet three cri-teria: (1) they enhance traditional law enforcementroles to provide a new set of response options forfrontline personnel that are tailored to the needs ofpeople with mental illnesses; (2) when appropriate,they establish a link for these individuals to servicesin the community; and (3) they are based in lawenforcement agencies with strong collaborative tiesto mental health partners, other criminal justiceagencies, and community members.8

Specialized law enforcement–based responseprograms include both the CIT and law enforcement–mental health co-responder models.

• The CIT model originated in the Memphis(Tenn.) Police Department and is therefore oftencalled the Memphis Model. It was developed inresponse to a tragic incident in which a lawenforcement officer used lethal force against aperson with a mental illness. This model isdesigned to de-escalate tensions at the scene andto reduce the need for use of force during thesetypes of encounters. To improve the likelihood ofa safe and effective outcome, the CIT modelincludes training and deployment of self-selected officers to provide a first-response to themajority of incidents involving people with men-tal illnesses.

• The co-responder model was developed in LosAngeles County and implemented soon after inSan Diego (Calif.). Leaders in those jurisdictionswere concerned that they were unable to link peo-ple with mental illnesses to appropriate services

or provide other effective and efficient responses.They identified limitations on officers’ time andlack of awareness about both community mentalhealth resources and the characteristics of indi-viduals who need access to those services asmajor obstacles. They then developed anapproach that pairs specially trained officers withmental health professionals to provide a joint sec-ondary response to the scene.

About the Elements

As the growing number of interested communitiesgrapple with implementing specialized law enforce-ment–based programs at the local level, there is acommensurate demand for more information on thekey elements of promising programs. Several com-munities have tried to identify critical program ele-ments, particularly for CIT initiatives, to promoteconsistency and quality.9 Until this BJA-supportedeffort, however, there had been limited debate oragreement at the national level about which elementswere essential to successfully implement any special-ized law enforcement–based response program—regardless of the specific model.

This report articulates 10 essential elements forany specialized law enforcement–based responseprogram. The elements are derived from recommen-dations made by a broad range of practitioners andother related experts to ensure they are practical andvaluable (see the “Document Development” section,p. ix). They provide practitioners and policymakerswith a common framework for program design andimplementation that will promote positive outcomeswhile being sensitive to every jurisdiction’s distinctneeds and resources. Each element contains a short

8. Many communities also have developed teams of community mentalhealth professionals, such as mobile crisis or assertive communitytreatment teams, to assist officers at the scene. While these modelsare undoubtedly a valuable resource for many communities anddepartments, they are not law enforcement–based and thus are notwithin the scope of this document. For further discussion of how lawenforcement have collaborated with mental health mobile crisisteams, see www.uc.edu/criminaljustice/ProjectReports/MCT_Report.pdf. For more on how mental health agencies have tailoredassertive community treatment teams to work with a justice-involved population, see www.gainscenter.samhsa.gov/text/ebp/Papers/ExtendingACTPaper.asp.

9. Most notably, promoters of the CIT model have recently formed anational group, the CIT National Organization (www.cit.memphis.edu/cno.html), to provide leadership and guidance to jurisdictionsimplementing CIT programs. Several members of the CIT NationalOrganization also serve on the advisory board that has guided thedevelopment of this publication, to ensure complementary products.The National CIT Organization’s guide describes critical elements ofthe CIT model using three categories: operational, ongoing, andsustaining elements. A draft of the guide is available at www.cit.memphis.edu/~cjus/dw.php?id=cjuscitdw01. In contrast, this docu-ment provides a framework for developing or enhancing elementsof a specialized law enforcement–based response of any type.

ixThe Essential Elements of a Specialized Law Enforcement–Based Program

statement (in italics) describing criteria that special-ized law enforcement–based response programsshould meet to be effective, followed by several para-graphs explaining the element’s importance and howits principles can be achieved.

The document reflects two key assumptions:First, each element depends on meaningful collab-oration among professionals in the criminal justiceand mental health systems. Although achieving therequisite level of collaboration is often difficult—particularly when faced with long-standing systembarriers—successful partnerships are needed tocarry out any of the elements. Second, law enforce-ment represents only the first of several criminal jus-tice agencies with which people with mental illnessesmay come in contact. Addressing problems raised bythe large numbers of people with mental illnesses inthe criminal justice system requires a comprehen-sive community- and systemwide strategy in whichthe law enforcement–based program plays only onepart. The impact of a specialized law enforcement–based response program on jails, courts, the commu-nity-based mental health system, and the larger com-munity must therefore be considered when planningand implementing the program.

The elements are meant to help guide individu-als in communities that are interested in developinga law enforcement–based program or improving theorganization and functions of an existing program.This document can be used as a practical planningtool for a specialized response at each stage of theprocess (e.g., designing the program, developing orenhancing policies and procedures, monitoringpractices, and conducting evaluations). This reportis meant to be a “living, breathing document” andthus will be updated or supplemented as specializedlaw enforcment–based programs mature, and toaddress new research studies that can provide astronger base of knowledge about how these pro-grams can best operate, their impact on the commu-nity and various affected systems, and the relativeimportance of the elements that form them.10

Document Development andRelated Materials

The essential elements are based on informationfrom a variety of sources, including interviews withlaw enforcement executives and officers, mentalhealth professionals, advocates, and mental healthconsumers who have been engaged in these pro-grams for many years, as well as a review of thescholarly literature. A panel of national expertsguided early drafts of this document. It was thenposted on a Web-based discussion forum throughwhich hundreds of stakeholders reviewed it andprovided feedback.11 An advisory group of leadingexecutives, practitioners, researchers, and otherexperts subsequently reviewed and discussed thecomments and suggested revisions.

The Bureau of Justice Assistance (BJA), U.S.Department of Justice, is developing a series ofresources for law enforcement practitioners andtheir community partners as part of BJA’s LawEnforcement/Mental Health Partnership Program.This report serves as the centerpiece of this series.The Improving Responses to People with Mental Ill-nesses series includes a collection of resources thatwill complement the essential elements: a practicalhandbook on implementing effective trainingstrategies; a monograph on tailoring law enforce-ment responses to the unique needs of the jurisdic-tion, which will include specific examples from thefield; and Web-based information on statewideefforts to coordinate these law enforcementresponses. Also available is an online database, theCriminal Justice/Mental Health Information Net-work, which includes profiles of local law enforce-ment responses to people with mental illnesses.This project is coordinated by the Council of StateGovernments Justice Center in partnership withthe Police Executive Research Forum.

10. Updates to this document will be available at www.consensusproject.org/issue-areas/law-enforcement.

11. Throughout this document, the term “stakeholders” is usedto describe the diverse group of individuals affected by lawenforcement encounters with people with mental illnesses, such

as criminal justice and mental health professionals; myriad otherservice providers, including substance abuse counselors and hous-ing professionals; people with mental illnesses (sometimesreferred to as “consumers”) and their loved ones; crime victims;and other community representatives.

1The Essential Elements of a Specialized Law Enforcement–Based Program

Specialized responses to people with mental ill-nesses are an outgrowth of community policing andas such should reflect a partnership between a lawenforcement agency and other stakeholder groupsand individuals. Partners for the lead law enforce-ment agency should include mental health serviceproviders, people with mental illnesses and theirfamily members and loved ones, and mental healthadvocates. Based on the nature of the problem,additional partners could include other area lawenforcement professionals; health and substanceabuse treatment providers; housing officials andother service providers; hospital and emergencyroom administrators; crime victims; other criminaljustice personnel such as prosecutors and jailadministrators; elected officials; state, local, and pri-vate funders; and community representatives. Anystakeholder may initiate the planning for the spe-cialized response, but to take root, the lead lawenforcement agency must fully embrace the effort.

At the outset of the planning process, leadersfrom each of the stakeholder agencies who haveoperational decision-making authority and commu-nity representatives should come together as a multi-disciplinary planning committee. This executive-levelcommittee should examine the nature of the prob-lem and help determine the program’s objectives anddesign (see Element 2, Program Design), taking intoconsideration how the committee will relate to othercriminal justice–mental health boards that may be inplace or are in the process of being established. The

planning committee also should provide a forum fordeveloping grant applications and working with localand state officials. Although focused primarily onplanning decisions, members should remainengaged during the implementation phase to provideongoing leadership and support problem solving anddesign modifications throughout the life of the pro-gram.

Agency leaders on the planning committee alsoshould designate appropriate staff to make up a pro-gram coordination group responsible for overseeingday-to-day activities. (In some jurisdictions, the twobodies may be the same—particularly those withsmall agencies, in rural areas, or with limitedresources.) This coordination group should overseeofficer training, measure the program’s progresstoward achieving stated goals, and resolve ongoingchallenges to program effectiveness. The group alsoshould serve to keep agency leaders and other poli-cymakers informed of program costs, develop-ments, and progress. Both groups’ members shouldreflect the community’s demographic composition.

To overcome challenges inherent in multidisci-plinary collaboration, including staff turnover andchanges in leadership, partnership and programpolicies should be institutionalized to the extentpossible. Interagency memoranda of understanding(MOUs) can be developed to address key issuessuch as how each organization will commitresources and what information can be sharedthrough identified mechanisms.

Collaborative Planning and Implementation

Organizations and individuals representing a wide range of disciplines and perspectives and witha strong interest in improving law enforcement encounters with people with mental illnesses worktogether in one or more groups to determine the response program’s characteristics and guideimplementation efforts.1

Ten Essential Elements

2 Improving Responses to People with Mental Illnesses

As a critical first step in the design process, the plan-ning committee should develop a detailed under-standing of the problems in its jurisdiction andidentify all contributing factors. In this analysis, it isimportant to understand the driving force(s) behindcurrent efforts to improve the law enforcementresponse. In some jurisdictions, law enforcementexecutives may become aware of the problembecause of a tragic incident. In others, executivesmay realize there are operational challenges pre-sented by particularly complex field encounters, suchas the inordinate amount of time officers spend wait-ing for medical clearance in emergency rooms or thefrequency with which officers repeatedly come incontact with the same individuals without an effec-tive resolution.

The committee must examine the reasons whythese incidents occur and other aspects of the prob-lem that may not have been raised by the single high-profile incident. It should look at law enforcementdata on calls for service, beat boundaries, feedbackfrom officers, community survey data, and othersources of information. To enhance their under-standing of root causes and available resources, com-mittee members also should examine factors such asthe community’s inpatient and outpatient treatmentoptions, crisis response services, ancillary servicessuch as housing and substance abuse treatment,population, and geography. They also may want totalk to people in other jurisdictions who have grap-pled with limited community resources to see whatalternatives are available to increase the reach ofexisting services.

The analysis of the problems and assessment ofavailable and potential resources to address themshould drive the short- and long-term goals of theprogram. For example, if the analysis reveals that asignificant barrier to improving the law enforcementresponse is that officers lack the training to safelyde-escalate situations involving people with mental

illnesses, one program goal would be to correct thisdeficiency. If officers cannot efficiently link people tomental health treatments, another goal may be torevise and streamline processes for connecting tothese services.

Once the program’s purpose is defined, the com-mittee must address personnel assignments andrelated considerations. The planning committee mustdecide whether some or all officers should be trainedto stabilize and de-escalate situations involving peoplewith mental illnesses in immediate response to thecall for service. Should all officers receive some base-line training and others receive more extensive train-ing? Should a subset of officers be trained to respondwith a mental health professional? When consideringthe answers to questions like these, the committeeshould explore the practical implications of differentstaffing options and present them to the chief lawenforcement executive or his or her designee on thecommittee. The committee also must help interpretthe criteria for emergency mental health evaluationand decide how officers will access that service. Thesedecisions will help the committee determine whichadditional skills and information the identified groupof responders should receive in training.

If committee members, including representa-tives from policing, conclude that a subset of officerswill respond to incidents involving people with men-tal illnesses, they should help the law enforcementexecutive determine how many officers are needed tocover all shifts and geographic districts. The commit-tee also should develop personnel selection criteriaand a process for identifying officers best suited forthe challenges of this new role. In particular, plan-ners should consider officers’ ability to reorient fromthe more traditional method of gaining control byusing an authoritative approach during a field con-tact to a nonadversarial, crisis-intervention style. Tothe extent possible, the selection process should bevoluntary, yet selective.

Program Design

The planning committee designs a specialized law enforcement–based program to address theroot causes of the problems that are impeding improved responses to people with mental illnessesand makes the most of available resources.2


Training must be provided to improve officers’responses to people with mental illnesses. Agenciesmay differ in the amount of training they offer:some will provide comprehensive training to allofficers, some will provide this training only to asubset, and some will provide basic training toeveryone in combination with more comprehensivetraining to a subset. At a minimum, a group of offi-cers sufficient to cover all time shifts and geo-graphic districts should receive extensive skills andknowledge training that builds on the more cursoryinformation routinely given on this topic at recruitand in-service trainings.12 The chief law enforce-ment executive should ensure that training is alsoprovided to supervisory and support personnel,such as midlevel managers, field training officers,call takers, and dispatchers, who advance thespecialized program’s operations.

Planning and implementing a training initia-tive that supports the specialized program shouldbe a collaborative effort between the law enforce-ment agency and stakeholders represented on theprogram coordination group. The coordinationgroup should help guide training decisions, whichinclude selecting content and techniques, ensuringthe instruction is culturally competent, identifyingand preparing trainers, and evaluating effective-ness. The group’s multidisciplinary/multisystemcomposition helps make certain that the traininginitiative reflects an appropriate range of perspec-tives; members can identify mental health practi-tioners, consumers, and family members to providesome of the training instruction. Likewise, the

group helps ensure quality by establishing a processfor consistently reviewing and evaluating trainingand then modifying the curriculum based on thefindings. The group can be particularly helpful inidentifying resources to defray law enforcementagency costs.

Specialized training should, at a minimum,provide officers with an improved understanding ofthe following: mental illnesses and their impact onindividuals, families, and communities; signs andsymptoms of mental illnesses; stabilization and de-escalation techniques; disposition options; commu-nity resources; and legal issues. Trainers shouldprovide sufficient opportunities for hands-onexperiential learning, such as role play and groupproblem-solving exercises.

Training should address issues specific to thecommunity in which it is being given. Mentalhealth personnel and other stakeholders should beinvited to participate in the specialized training tohelp improve cross-system understanding of agen-cies’ roles and responsibilities, as well as to conveyany requirements for accessing community-basedservices. Planners should brief any trainers outsidelaw enforcement about effective techniques, lan-guage, and sensitivities to the law enforcement cul-ture that will improve their connection with thisaudience. When possible, additional cross-trainingshould be provided to improve the mental healthprofessionals’ understanding of law enforcementissues, such as ride-alongs and other opportunitiesto see policies translated into action.

Specialized Training

All law enforcement personnel who respond to incidents in which an individual’s mental illnessappears to be a factor receive training to prepare for these encounters; those in specializedassignments receive more comprehensive training. Dispatchers, call takers, and other individualsin a support role receive training tailored to their needs.3

12. For more information on various types of training opportunitiesfor law enforcement personnel, see Council of State Govern-ments, Criminal Justice/Mental Health Consensus Project Report

(New York, N.Y.: Council of State Governments, 2002),www.consensusproject.org.


When 911 or other call takers receive a request forservice they suspect involves a person with a mentalillness, they should gather descriptive informationon the person’s behavior; determine whether theindividual appears to pose a danger to him- or her-self or others; ascertain whether the person pos-sesses or has access to weapons; and ask the callerabout the person’s history of mental health or sub-stance abuse treatment, violence, or victimization.All call takers should receive training on how to col-lect the most useful information quickly. To supple-ment this training, members of the coordinatinggroup with mental health backgrounds shoulddevelop a concise list of questions for call takers tohave on hand when answering service requests thatseem to involve someone with a mental illness.

Call takers and dispatchers must have anunderstanding of the purpose of the specializedprogram and how it works—particularly what typesof calls for service should be directed to particularofficers or teams. Dispatchers must be providedwith up-to-date information on staffing patternsduring all shifts and over all geographic areas thatidentify law enforcement or mental health respon-ders designated to respond to calls that appear toinvolve a person with a mental illness.

The coordinating group should also providethese personnel with specific guidance on how torecord information in the dispatch database aboutcalls in which mental illness may be a factor. Theinformation should be used for assessing proce-dures, informing future responses, and evaluatingprogram outcomes (see Element 10 for more onhow evaluations promote sustainability). Locationsof repeat calls for service involving individuals withmental illnesses can be coded to help ensure thatspecially trained officers will be dispatched torespond to those locations in the future. Coding canhelp agencies ultimately reduce call and transporttime, as well as potential injuries to all involved, bydispatching experienced officers. To protect com-munity members’ privacy, the notes made on theselocations must never identify specific individualsand must be reviewed periodically to ensure accu-racy (see Element 7 for more on confidentiality con-cerns). Responding officers should also validate andupdate this information when they clear a call tothat location. All communications personnel andresponding officers should be instructed to avoidusing slang and pejorative language when describ-ing individuals thought to have a mental illness.

Call-Taker and Dispatcher Protocols

Call takers and dispatchers identify critical information to direct calls to the appropriateresponders, inform the law enforcement response, and record this information for analysisand as a reference for future calls for service.4


Specialized law enforcement–based response pro-grams are designed to resolve officers’ encounterswith people with mental illnesses safely and, whenappropriate, link these individuals to mental healthsupports and services that reduce the chances forfuture interactions with the criminal justice system.The success of these programs is contingent on offi-cers’ using tactics that safely de-escalate situationsinvolving someone who is behaving erratically or isin crisis. The high prevalence of trauma histories inthis population requires the use of trauma-informed responses. In addition to de-escalatingthe incident, responding officers should assesswhether a crime has been committed and observethe person’s behavior within the given circum-stances to determine if mental illness may be a fac-tor. Officers should draw upon expertise acquired inspecialized training and from their experiences toidentify signs and symptoms of mental illness. Offi-cers must ascertain whether the person appears topresent a danger to him- or herself or others. Toassist in this determination, officers may gatherinformation from knowledgeable individuals at thescene, including mental health co-responders.

Officers must make disposition decisionsbased on their observations, information theygather at the scene, and their knowledge of commu-nity services and legal mandates. To assist officersin their decision making, the planning committeeshould develop clear guidelines that are consistentwith the program’s goals and governing authorities.For example, such programs might promote alter-natives to incarceration for eligible individuals. If aperson has come to the attention of law enforce-ment because of behaviors that appear to resultfrom a mental illness and no serious crime hasbeen committed, guidelines and protocols consis-tent with existing law should enable officers to

divert the individual to mental health supports andservices. When a serious crime has been commit-ted, the person should be arrested.

To make these decisions, officers must be famil-iar with available community resources—particu-larly any 24-hour center that can receive individualsin mental health crises. Officers also must under-stand their state’s criteria for involuntary emergencyevaluation to make appropriate decisions regardingwhether to detain and transport the person to a facil-ity where he or she can undergo an emergency men-tal health evaluation. Officers must take intoconsideration both the individual’s treatment needsand civil liberties and should pursue voluntary com-pliance with treatment whenever possible.

In the rare case when an incident involves bar-ricaded individuals or de-escalation fails, respondingofficers will require additional support. Some agen-cies may equip officers who most frequentlyencounter people with mental illnesses with less-lethal weapons, so as to minimize injuries that couldoccur if there is a threat to safety and some use offorce becomes necessary. Agencies should provideofficers with additional training on the safe andappropriate deployment of these weapons andshould establish protocols to guide officers in theirdecisions to use them. The planning committee alsoshould develop protocols to make certain there iseffective coordination during such incidents amongspecialized law enforcement responders, SWATteams, and mental health professionals. Althoughagencies often are under pressure to resolve thesesituations quickly, it may be best, when there is noimminent threat of danger, to allow time for mentalhealth personnel with expertise in crisis negotiationand law enforcement operations to communicatewith the individual.

Stabilization, Observation, and Disposition

Specialized law enforcement responders de-escalate and observe the nature of incidents inwhich mental illness may be a factor using tactics focused on safety. Drawing on theirunderstanding and knowledge of relevant laws and available resources, officers thendetermine the appropriate disposition.5


Law enforcement is authorized to provide trans-portation for people who are under arrest or whothey believe meet the criteria for emergency evalua-tion (whether the evaluation is voluntary or involun-tary). These individuals are in law enforcementcustody, and rules and regulations regardingrestraints in custodial situations apply.13 Given thefrequent history of traumatic experiences amongpeople with mental illnesses, custodial restraintsmay create acute stress, which in turn may escalatetheir degree of agitation. Law enforcement execu-tives, with input from other program planners,should review policies regarding restraints in custo-dial situations and balance considerations of officerand citizen safety with the impact of these controlson people with mental illnesses.

The planning committee should identify facili-ties that are capable of assuming custodial respon-sibility, are available at all times, and have personnelqualified to conduct a mental health evaluation.14

Speedy custodial transfer is critical to the overallsuccess of law enforcement responses. To enableofficers to return quickly to their duties, staff in the

receiving facility should efficiently and accuratelyobtain relevant law enforcement information. Pro-tocols should ensure that medical clearance isachieved in a timely manner and that peoplebrought by law enforcement are never turned away.If law enforcement responders determine that theperson with a mental illness should be arrested andofficers take the person to jail or lockup, then qual-ified staff should be available to screen the arresteeat intake for mental health status, medicationneeds, and suicide risk.

In noncustodial situations in which the persondoes not meet the criteria for emergency evaluationand is not under arrest—but officers determine he orshe would benefit from services and support—officersshould try to connect the individual with a friend orfamily member, peer support group, or treatmentcrisis center. Similarly, officers should seek toengage the services of the individual’s current men-tal health provider or a mobile crisis team. In somejurisdictions, law enforcement may also collaboratewith mental health professionals to help transportindividuals to evaluation or treatment facilities.

Transportation and Custodial Transfer

Law enforcement responders transport and transfer custody of the person with a mental illness ina safe and sensitive manner that supports the individual’s efficient access to mental healthservices and the officers’ timely return to duty.6

13. Law enforcement agencies generally define custody using a caselaw standard that can be described as whether or not a “reason-able person” would feel free to leave.

14. H. Steadman and colleagues have used the term “specializedcrisis response site” (SCRS) to refer to such a facility. SCRSs aredefined as “sites where officers can drop off individuals in psychi-atric crisis and return to their regular patrol duties. These [pre-booking diversion] programs identify detainees with mental

disorders and work with diversion staff, community-basedproviders, and the courts to produce a mental health dispositionin lieu of jail.” They also can link individuals to substance abuseand other treatment. See H. Steadman, K. Stainbrook, P. Griffin,J. Draine, R. Dupont, and C. Horey, “A Specialized CrisisResponse Site as a Core Element of Police-Based DiversionPrograms,” Psychiatric Services 52 (2001): 219–222.


Law enforcement and mental health professionalsshould exchange information about people with men-tal illnesses who frequently come in contact with thejustice system for many reasons: foremost amongthem, information sharing is essential to achievedesired outcomes by helping responders be more sen-sitive to individual needs, reduce injury, and enhancetheir ability to determine next steps. To facilitate anappropriate disposition decision, law enforcementofficers should collaborate with mental health profes-sionals to better understand the individual’s mentalhealth needs. Similarly, mental health providers work-ing at receiving facilities can conduct a more effectivemental health evaluation if law enforcement officersshare their observations regarding the person’s behav-ior at the scene. In addition to improving the out-comes of specific incidents, sharing informationacross systems will help program planners as theydevelop the program and its outcome measures.

The program’s planning committee should care-fully consider the type of information needed andexisting barriers to its exchange and then develop pro-cedures (and in some cases MOUs) to ensure thatessential information is shared in an appropriate man-ner. These protocols should be reviewed during cross-training sessions, which will provide law enforcementand mental health professionals an opportunity todevelop relationships with their counterparts andlearn why they need certain information. Agency lead-ers also can explore the possibility of linking informa-tion systems to share certain information either on anongoing or a one-time basis.15

Information should be shared in a way that pro-tects individuals’ confidentiality rights as mentalhealth consumers and constitutional rights as poten-tial defendants. The planning committee should

determine which personnel have the authority torequest and provide information about an individual’smental health and criminal history. In general, mentalhealth records should be maintained by mental healthprofessionals. Information exchanges should be lim-ited strictly to what is needed to inform an appropriateincident response or disposition, and officers shouldfocus on documenting observable behaviors only. Allcommunications must, of course, comply with stateand federal laws requiring the confidentiality of men-tal health records, such as the Health Insurance Porta-bility and Accountability Act.16 Cross-training shouldensure that program staff understand relevant stateand federal regulations about issues such as how med-ical information is released, secured, and retained.

Individuals with mental illnesses who have beenin contact with a mental health agency should beoffered an opportunity to provide consent in advancefor mental health providers to share specified infor-mation with law enforcement authorities if an inci-dent occurs (sometimes called an advance directive).17

Individuals should be asked if an advance directiveexists, and if so what the instructions are and whoshould be contacted to verify this information.

Officers can play an important role in exchanginginformation with family members and crime victimsby providing explanations about criminal proceedingsor diversion programs. They may inform the personwith a mental illness and his or her family membersabout mental health treatment linkages and how toaccess other services or support groups, such as thoserelated to substance use disorders. Law enforcementofficers also can assist victims of crimes committed bypeople with mental illnesses by providing informationabout protective orders, victim support groups, andother services.

Information Exchange and Confidentiality

Law enforcement and mental health personnel have a well-designed procedure governing therelease and exchange of information to facilitate necessary and appropriate communicationwhile protecting the confidentiality of community members.7

15. The Bureau of Justice Assistance has supported groundbreakingadvances that facilitate the electronic exchange of informationbetween agencies. To learn more about efforts involving the devel-opment of national policies, practices, and technology capabilitiesthat support effective and efficient information sharing, seewww.it.ojp.gov.

16. For more information, see John Petrila, “Dispelling the Myths aboutInformation Sharing between the Mental Health and Criminal

Justice Systems,” National GAINS Center for Systemic Change forJustice-Involved People with Mental Illness (February 2007).

17. For more information on psychiatric advance directives, see theNational Resource Center on Psychiatric Advance Directives (NRC-PAD), at www.nrc-pad.org. NRC-PAD provides an overview, forms tocomplete psychiatric advance directives, links to state statutes, educa-tional Web casts and discussion forums, and other resources.


Law enforcement officers often are called torespond to incidents that are the manifestation ofan untreated or inadequately treated mental illness.Specialized law enforcement–based responses pro-vide an opportunity to link these individuals to com-munity mental health supports and services thatpromote long-term wellness and reduce the chanceof future negative encounters with officers.

When law enforcement responders bring indi-viduals who are not under arrest to licensed mentalhealth professionals at a receiving facility, staffthere should be qualified to conduct a mental healthevaluation; assess the contributions of mental ill-ness, substance abuse, and other medical condi-tions to current behavior; and manage crisissituations. With their knowledge of available com-munity-based treatment resources, mental healthprofessionals can then link the individual to neededsupports and services.

Individuals with mental illnesses often requirean array of services and supports, which can includemedications, counseling, substance abuse treatment,

income supports and government entitlements,housing, crisis services, peer supports, case man-agement, and inpatient treatment. Planners ofthe specialized response program should anticipatethe treatment needs of the individuals with whomlaw enforcement will come in contact and workwith service providers in the community to betterensure these needs can be met and coordinated.

Because many individuals with mental ill-nesses who come into contact with law enforcementhave co-occurring substance use disorders, follow-up services will be most effective when delivered byproviders with the capacity to integrate treatmentapproaches. Accordingly, the planning committeeshould consider how the program can help connectindividuals with co-occurring disorders to inte-grated treatment and should advocate for greateraccess to this and other evidence-based practices.18

Planners should pay special attention to the serviceneeds of racial and ethnic minorities and women bymaking culturally competent and gender-sensitiveservices available to the extent possible.

Treatment, Supports, and Services

Specialized law enforcement–based response programs connect individuals with mental illnessesto comprehensive and effective community-based treatment, supports, and services.8

18. For our purposes here, evidence-based practices (EBPs) refer tomental health service interventions for which consistent scientificevidence demonstrates their ability to improve consumer out-comes. 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): 179–182. Other EBPs includeassertive community treatment, psychotropic medications, sup-ported employment, family psychoeducation, and illness self-management. For more information on the application of EBPsin forensic settings, see materials produced by the NationalGAINS Center at www.gainscenter.samhsa.gov/html/.


Law enforcement leaders who recognize the valueof a specialized response program to reduce repeatcalls for service and produce better outcomes forpeople with mental illnesses must create an organi-zational structure to support it. Leadership cannotbe limited to endorsing the program and authoriz-ing staff training. Establishing that the responseprogram is a high priority for the agency is essentialand is best demonstrated through visible and prac-tical changes in how the agency partners with thecommunity and realigns internal processes.

Specifically, leaders should embrace new part-ners and foster a supportive culture through fre-quent messages about the value of this type of “real”policing work. Communications with officers atevery level of the agency should stress the benefitsof the response program. Officers should beencouraged to volunteer for the program’s assign-ments when possible, rather than receive manda-tory reassignment. Enlisting the support ofsupervisors and field training officers is critical totransforming how the program will be viewed byothers in the agency. A program “champion” in aposition of authority within the agency and with ademonstrated commitment to the specialized pro-gram should be identified to serve as the agency’srepresentative on the coordination group and theprogram’s representative within the agency.

Leaders should modify officers’ performanceevaluations to take into account the initiative’sunique objectives. As a program designed toimprove the safety of all those involved in an inci-dent and to reduce the number of people inappro-priately taken into custody, success should not bemeasured by the number of arrests. As with othersuccessful law enforcement problem-solvingefforts, personnel performance should be evaluatedand rewarded based on officers’ success collaborat-ing with and making referrals to community part-ners, addressing the underlying causes of calls forservice, and taking measures that reduce the needfor force.19 The law enforcement agency and plan-ning committee should acknowledge these profes-sionals’ hard work through commendationceremonies and other forms of recognition.

Agency leaders may need to adjust officers’schedules, obtain grants, or devote funds to special-ized program training, create new positions dedicatedto coordinating program activities and recruiting andscreening responding officers, and revise deploymentstrategies to maximize the availability of trained lawenforcement responders across shifts and geographicareas. Agencies may find it beneficial to develop astandard operating procedure to enumerate specificprocesses and roles and responsibilities within theprogram. In some jurisdictions, these issues willrequire close cooperation with labor unions.

Organizational Support

The law enforcement agency’s policies, practices, and culture support the specialized responseprogram and the personnel who further its goals.9

19. For more information on innovative personnel performancemeasures for community policing initiatives, see Mary AnnWycoff and Timothy N. Oettmeier, Evaluating Patrol Officer

Performance under Community Policing: The Houston Experience,U.S. Department of Justice (Washington, D.C.: National Instituteof Justice, 1993).


The planning committee should take steps early inthe design process to ensure the program’s long-term sustainability. Accordingly, the committeeshould identify performance measures based onprogram goals; these measures should considerquantitative data on key aspects of program opera-tion, as well as qualitative data on officers’ and com-munity members’ perceptions of the program. Itmay be helpful to aggregate baseline data before pro-gram implementation for later comparisons withnew program information. To the extent possible,existing law enforcement and mental health agencydata collection mechanisms should be adapted toaccommodate the program’s specific needs; plan-ners may consider engaging a university partner toguide these data collection efforts. The planningcommittee should work with law enforcement andmental health agencies to ensure that the data arecollected accurately and appropriately.

The data law enforcement personnel collectshould focus on questions most critical to the pro-gram’s success in achieving its goals, including thenumber of injuries and deaths to officers and civil-ians; officer response times; the number of inci-dents to which specially trained officers responded;the number of repeat calls for service; officers’ dis-position decisions, such as linking a person withservices; and time required and method used forcustodial transfer. Data should be used to refineprogram operations as needed, as well as reviewindividual case outcomes and determine if follow-up by a mental health professional is warranted.

Program leaders should gauge the attitudes ofcommunity leaders, the media, key public officials,and other policymakers toward the program. It maybe helpful to engage elected officials early in theprocess and keep them involved—from the initialkickoff through refunding and long-term imple-mentation—to promote sustainability and desiredlegislation. The committee also should survey offi-cers—both specialized responders and others—sothat law enforcement leaders can better assess theprogram’s usefulness to the entire department andaddress any concerns. Based on this information,the planning committee should determine the mosteffective way to promote the program’s positiveimpact on the community, individuals, and agen-cies and respond to program shortcomings or high-profile tragic events.

While in-kind contributions from partners cango a long way toward offsetting certain programcosts, planners should identify and cultivate long-term funding sources to cover costs that would oth-erwise fall to the law enforcement agency to absorb.Requests for funding should be based on clearlyarticulated program goals and, to the extent possi-ble, should incorporate data demonstrating pro-gram outcomes.

Departments also should focus on sustaininginternal support for the program, such as offeringrefresher training to help officers refine their skillsand expand their knowledge base. To promote longer-term commitments from specialized officers, depart-ments also should provide incentives and otherorganizational support for serving in the program.

Program Evaluation and Sustainability

Data are collected and analyzed to help demonstrate the impact of and informmodifications to the program. Support for the program is continuously cultivatedin the community and the law enforcement agency.10


Many law enforcement agencies around the nationstruggle to respond effectively to people with mentalillnesses. Officers encounter these individuals whencitizens call them to “do something” about the manexhibiting unusual behavior in front of their busi-ness, the woman sleeping on a park bench, or some-one who is clearly in need of mental healthservices—whether or not a crime has been commit-ted. Law enforcement professionals in many juris-dictions have lacked community-based support,guidance, and a clear framework for crafting a pro-gram to improve their response to people with men-tal illnesses.

But innovative solutions are at hand. Increas-ingly, law enforcement agencies of all sizes are imple-menting creative approaches despite scarceresources. The range of approaches in communitiesacross the country reflects the realization that strate-gies must be tailored to each jurisdiction’s uniqueneeds. These agencies are engaged in problem solv-ing with a range of partners from diverse disciplines

and have access to a growing pool of programs andknowledge about promising practices. This publica-tion outlines the essential elements of successful spe-cialized law enforcement–based efforts that reflectthis expanded knowledge base and experience to bet-ter guide practitioners initiating or enhancing theirown programs.

The tone of the elements may suggest that thesechanges are easy to make. They are not. There aremany challenges to these efforts, including politics,turf battles, competition for limited funding, lack oflegal foundations for officers’ actions, and scarce lawenforcement and community mental healthresources. Leaders in jurisdictions that have imple-mented a specialized response acknowledge that ittakes commitment to overcome these obstacles, butagree that the costs—in dollars and human lives—are too high to sanction continuing with only moretraditional law enforcement responses to people withmental illnesses. Their efforts have resulted inincreased public safety and improved public health.

Conclusion

The Bureau of Justice Assistance, Office of Justice Programs,U.S. Department of Justice, provides leadership training, techni-cal assistance, and information to local criminal justice agenciesto makeAmerica’s communities safer. Readmore atwww.ojp.usdoj.gov/BJA/.

The Council of State Governments (CSG) Justice Center is anational nonprofit organization serving policymakers at thelocal, state, and federal levels from all branches of government.The CSG Justice Center provides practical, nonpartisan adviceand consensus-driven strategies, informed by available evidence,to increase public safety and strengthen communities. Readmore at www.justicecenter.csg.org.

The CSG Justice Center also coordinates the CriminalJustice/Mental Health Consensus Project. This project is anunprecedented national effort to improve responses to peoplewith mental illnesses who become involved in, or are at risk ofinvolvement in, the criminal justice system. Readmore atwww.consensusproject.org.

The Police Executive Research Forum (PERF) is a nationalmembership organization of progressive police executives fromthe largest city, county, and state law enforcement agencies.PERF is dedicated to improving policing and advancing profes-sionalism through research and involvement in public policydebate. Readmore at www.policeforum.org.

Council of State GovernmentsJustice Center

www.justicecenter.csg.org

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Law Enforcement Essential Elements - Bureau of Justice Assistance

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