Crisis Intervention Team (CIT)

Crisis Intervention Team (CIT)
Name	Crisis Intervention Team
Abbreviation	CIT
Formation	1988
Founder	Sergeant Sam Cochran; psychiatrist Dr. Sandra Smith
Type	Law enforcement–mental health collaboration
Region	International
Services	Crisis response; diversion; de-escalation; community partnerships

Crisis Intervention Team (CIT) Crisis Intervention Team (CIT) refers to programs that pair specially trained law enforcement officers with mental health providers to improve responses to people experiencing psychiatric crises. Originating in the late 1980s, CIT models emphasize de-escalation, diversion from criminal processing to treatment, and partnerships among police, emergency services, hospitals, and advocacy groups. The approach has been adapted across municipal, county, and national systems and intersected with reforms in policing, public health, and legal frameworks.

History

The CIT model began in 1988 in Memphis, Tennessee following a police encounter that resulted in the fatal shooting of a person with an untreated psychiatric disorder; stakeholders including the Memphis Police Department, National Alliance on Mental Illness, and local hospitals collaborated to design a specialized response. Early adopters cited models of community policing from Boston Police Department, influences from crisis stabilization programs in New York City, and precedent work by psychiatric emergency services at Crisis Stabilization Units in Chicago and Los Angeles County. During the 1990s and 2000s the model spread through initiatives promoted by organizations such as the President's New Freedom Commission on Mental Health and training networks connected to the Substance Abuse and Mental Health Services Administration and the Bureau of Justice Assistance. International adaptations appeared in Canada, United Kingdom, Australia, and parts of Europe influenced by WHO policy dialogues and WHO Mental Health Action Plan discussions.

Model and Components

Core components include selection of volunteer officers within agencies like the New York Police Department or Los Angeles Police Department, partnerships with mental health providers such as Johns Hopkins Hospital and Mayo Clinic, designation of psychiatric receiving centers (for example, municipal hospitals similar to Cook County Hospital), and interagency governance bodies resembling coordination seen in King County and Multnomah County. Typical elements mirror crisis systems in 1960s deinstitutionalization shifts and draw on clinical practices from institutions including Harvard Medical School and Stanford University School of Medicine. Components often consist of dispatch protocols based on systems like Enhanced 911, memoranda of understanding similar to interlocal agreements used by Los Angeles County Department of Health Services, and data-sharing arrangements inspired by initiatives at Centers for Disease Control and Prevention collaborations.

Training and Curriculum

Training curricula commonly incorporate didactic sessions, scenario-based role play, and rides-along experiences with clinicians from centers such as Sheppard–Pratt Health System or academic programs at University of California, San Francisco. Course content frequently covers recognition of psychosis referencing diagnostic frameworks like DSM-5, suicide risk assessment methods informed by Columbia-Suicide Severity Rating Scale work, and legal considerations paralleling statutes such as the Mental Health (Care and Treatment) Act in various jurisdictions. Trainers often include representatives from advocacy organizations such as NAMI and clinical faculty from Yale School of Medicine or King's College London, and curricula may adapt models from the Police Executive Research Forum and research produced by RAND Corporation.

Implementation and Variations

Implementation varies widely: some jurisdictions adopt full-time co-responder models similar to programs in Portland, Oregon and Seattle that pair clinicians with officers, while others use mobile crisis teams modeled after services in Melbourne and Toronto. Variants include CIT-lite approaches in smaller agencies like those in Rural Iowa or peer-led response teams reflecting practices from Peer Support Specialist programs and Veterans Affairs collaborations (e.g., Department of Veterans Affairs). Large systems such as the Metropolitan Police Service (London) or the Royal Canadian Mounted Police have integrated CIT principles into broader mental health strategies, while municipal systems like Detroit and Philadelphia emphasize diversion agreements with psychiatric emergency departments.

Outcomes and Evaluation

Evaluations report mixed but generally favorable outcomes: reductions in arrests for people with mental illness have been documented in studies drawing on data from University of Cincinnati, Johns Hopkins Bloomberg School of Public Health, and University of Pennsylvania, and many evaluations cite decreased use of force in partnerships like those in Memphis and Cincinnati. Other analyses by American Psychological Association-affiliated researchers and by think tanks such as Brookings Institution highlight improvements in linkage to treatment and community satisfaction; however, rigorous randomized trials remain limited compared with quasi-experimental and observational work seen in reports from Urban Institute and RAND Corporation.

Criticisms and Challenges

Critics include civil rights advocates from organizations such as ACLU and service users associated with Mental Health America, who argue CIT can legitimize police as default crisis responders and stress the need for non-police alternatives inspired by models in Copenhagen or peer-run initiatives in San Francisco. Implementation challenges involve funding constraints tied to grants from Department of Justice programs, inconsistent fidelity to core elements documented by researchers at University of North Carolina and Vanderbilt University, and coordination problems among agencies akin to those described in interagency reform efforts in New Orleans. Questions remain about scalability in rural areas like Appalachia and about long-term outcomes for populations experiencing homelessness linked to research by National Coalition for the Homeless.

Policy and Legislative Context

Policy frameworks have shaped CIT adoption through federal and state initiatives such as guideline endorsements from Substance Abuse and Mental Health Services Administration and funding streams from the Office of Juvenile Justice and Delinquency Prevention and Bureau of Justice Assistance. State legislation in jurisdictions like Ohio, Georgia, and Maryland has codified diversion pathways or training requirements, while municipal ordinances in cities including Cleveland and San Antonio have formalized interagency protocols and reporting obligations. International policy linkages involve WHO guidance and comparative law work by institutions such as European Court of Human Rights in contexts where mental health and policing intersect.

Category:Crisis response programs