Mondays through Thursdays, at 7 AM, a few dozen police officers assemble at the New York Police Academy to receive instruction in how to manage calls involving mentally disturbed individuals. Known as Crisis Intervention Team training, or CIT, the program—launched in 2015 and committed to training 5,500 NYPD cops, or one-quarter of all patrol officers, by next year—teaches techniques patterned on those used in hostage negotiations. Throughout the four-day course, cops learn about the history of mental illness in America and its varieties, symptoms, and prospects for treatment, and they participate in scenarios with actors playing people in states of acute psychiatric crisis. The overarching aim is de-escalation: after CIT, an officer should be better prepared to resolve tense encounters with mentally ill individuals than an officer lacking the training.
CIT has broad support in mental health policy circles. The 21st Century Cures Act, signed into law last December by President Obama and developed in large measure by congressional Republicans, revised federal public-safety grant programs to allow funding for state and local CIT efforts. New York State’s recently enacted budget increased funding for CIT. Last fall, CIT became a more prominent issue in New York because of the death of Deborah Danner, a 66-year-old Bronx resident with schizophrenia shot by a police officer who had not gone through CIT instruction.
In his classic study Varieties of Police Behavior, James Q. Wilson wrote: “The patrolman’s role is defined more by his responsibility for maintaining order than by his responsibility for enforcing the law” [emphasis in original]. For police, maintaining order in the streets has never been easy, and it has become tougher for two reasons. First, tensions between police and the communities they patrol have deteriorated since the rise of Black Lives Matter. Attacks on cops are up. According to the National Law Enforcement Officers Memorial Fund, 64 police officers were shot and killed in 2016, compared with 41 in 2015. Second, the United States mental health-care system has become increasingly fragmented. Instead of caring for the mentally ill almost exclusively in psychiatric hospitals, as was generally done until the 1960s, governments at all levels now try to connect them with care in communities. Though it is broadly assumed that “deinstitutionalization”—the process of transitioning the locus of care from an inpatient to outpatient setting—happened many years ago, it is in fact ongoing. Under New York governor Andrew Cuomo’s “Transformation Plan” for the state Office of Mental Health, for example, the average daily census of adults in state mental hospitals has dropped by 11 percent over the past two years. Connecting the mentally ill with treatment in communities has proved easier said than done. A striking indicator that deinstitutionalization has not lived up to its promise: the high rates of mental illness among our incarcerated population. Despite numbering less than one in 20 of the adult population, the seriously mentally ill constitute one in five jail and prison inmates.
Before the mentally ill wind up behind bars, their first point of contact with the criminal-justice system is with patrol officers—an encounter that sometimes ends tragically. According to data maintained by the Washington Post, at least 25 percent of those people fatally shot by police last year were mentally ill; some studies estimate that as many as half of all those fatally shot by police are mentally ill. Many advocates are keen to downplay any link between violence and serious mental illness, but the connection is compelling. As D. J. Jaffe explains in his recent book Insane Consequences, studies that have purported to discredit or weaken this link typically fail to distinguish between the treated and untreated seriously mentally ill. It is the second group that commits acts of violence at rates above that of the general population. It’s hard to blame any patrol officer for being on edge when responding to an “emotionally disturbed person” (EDP) call. Last year, New York police officers responded to such calls at a rate of more than 400 per day, an increase from the prior year. CIT is thus a reasonable policy response to the reality that the mentally ill will likely remain heavily involved with the criminal-justice system for the time being.
Many calls for service concerning the mentally ill don’t involve any serious criminal activity. But even when a crime hasn’t occurred, the public—or whoever called 911—expects the responding officers to address the immediate crisis. To de-escalate such situations, CIT-trained officers use a number of communication strategies: speak calmly, reduce external distractions and stimulations, ask open-ended questions, set boundaries, decline to “buy in” to a mentally ill individual’s delusion, show respect, allow them to save face, and build a rapport. CIT instruction trains actors in various scenarios involving different forms of mental illness, such as PTSD, borderline personality disorder, and severe depression. Officers try to manage these situations and get feedback from staff from the Center for Urban Community Services, the organization that conducts CIT training with the NYPD. The point is not to turn patrol officers into social workers or clinicians but to improve their ability to manage EDP calls without making them “own” a problem that is fundamentally the responsibility of the mental health-care system.
Some form of CIT is in use where approximately half the U.S. population lives, though the quality and nature of these programs varies. The NYPD’s program is distinctive in two ways. First, whereas in the original “Memphis” model—named for the Memphis Police Department, which originated the training—dispatchers send out specially trained officers to be the lead on responses to calls, like a SWAT team for mental crises (hence “crisis intervention team”), the NYPD focuses simply on training as many officers as possible. The nearest patrol car will still respond first to a call, though it may not be carrying a CIT-trained officer; NYPD commanding officers will then order available CIT-trained patrol cops to the scene “when necessary and feasible.” The department aims to have at least one CIT-trained officer and supervisor available at all times in every precinct.
Second, the NYPD’s CIT program places strong emphasis on “self-care”: officers receive instruction in how common PTSD is among urban police officers and about the importance of seeking treatment. The goal is to refute the “stigma” that cops are said to experience over admitting to others that their mental health is suffering. The NYPD believes that self-care is important not only for officers’ well-being but also because officers who can empathize with those suffering from mental illness will be more effective in dealing with them.
One recent instance of scenario training at the NYPD’s CIT program went as follows. Two officers arrive at an apartment after an EDP call comes in. The door is answered by a man who looks worried, while his disheveled brother can be seen pacing in the living room behind him and muttering to himself. The man who opened the door tells the officers that he called the police to come pick up his brother, who hasn’t taken his medication in six weeks and whose behavior is scaring the man’s wife. “He hasn’t done anything yet, but the last time he went off his medication, he tried to attack me for asking him to turn the TV down.” One of the officers slowly enters the apartment, approaches the brother, and asks a brief, open-ended question. “What is it that has you so upset today?” The brother frantically responds, “I can’t stay here anymore! I can’t stay here anymore!” The officer keeps his distance and repeats the man’s words back to him in an attempt to build rapport. “Okay. You can’t stay here anymore. Why is that?” The brother, who is still pacing the room, yells back that whispering voices are telling him that he is being watched. The police officer displays empathy but doesn’t buy in to the hallucination, saying, “I don’t hear these voices, but I believe that you do.” By continuing to listen patiently, the officer is eventually able to get the disturbed man to sit down on the couch and ask him why he hasn’t been taking his medication. The man looks at his feet, responding that it makes him feel restless and anxious. The officer suggests that they go to the hospital to see if there is a different medication that he can try. Ultimately, the man agrees to be taken to the hospital, as long as he doesn’t see the same doctor who prescribed him the previous medication.
No definitive study of New York’s CIT initiative has been conducted yet. A January 2017 report by the department’s inspector general questioned the NYPD’s ability to evaluate itself, saying that the department is not doing enough to track outcomes for EDP calls. For any department, it is difficult to quantify CIT’s success, because, as Sam Cochran, the architect of the Memphis model explains, “How do you prove [that] something doesn’t happen?” Police shootings are rare events. Proponents of CIT cite studies that show how programs in other cities have reduced the “criminalization of mental illness” by lowering the number of “bookings” resulting from mental health crisis calls.
Still, patrol officers’ principal responsibility remains to maintain order in public spaces and private locations where their services have been requested—not to cure people with schizophrenia. In a 2013 blog post titled “Don’t Blame the Police,” the Treatment Advocacy Center wrote: “The transfer of responsibility for persons with mental illness from mental health professionals to law enforcement officers . . . harms both the patients and the officers.” The Deborah Danner shooting, for which the officer in question has been indicted for second-degree murder, is a case in point. A few days after Danner was shot, Kenneth J. Dudek, head of the mental health service provider Fountain House, blamed a “flawed and fractured mental health system” for her death. Dudek writes that, between 2003 and 2013, Danner was a “thriving member” of Fountain House, whose “clubhouse” model provides community services to the seriously mentally ill on a voluntary basis. She worked, attended school, and pursued artistic interests. A switch in her medication regime caused her to deteriorate, with the result that “Deborah had been frequently hospitalized for her illness, was refusing to take her medication and had been involved in several similar disturbance calls responded to by the NYPD.” More crucially, city government cut Fountain House’s budget for outreach, thus depriving this highly respected organization of hundreds of thousands of dollars that might have helped counselors reconnect with Danner. Countless mental illness–related tragedies fit this pattern: failure to invest in effective programs, fatalism over what to do about someone who refuses treatment, and years of blown opportunities to reverse the course of deterioration—leading to a violent death.
Ultimately, the Deborah Danner case says more about the state of the mental health-care system than about the NYPD. That hundreds of these encounters are negotiated each day without resulting in a tabloid-worthy tragedy says a great deal about how effectively, even without CIT, the average NYPD patrol officer copes with mental health crises. In midtown precincts, such emergencies emerge on an hourly basis. CIT is a worthy program, but its popularity should not divert resources or attention from genuine mental health-care reform. A truly humane and effective mental health-care system would have no need for something like CIT in the first place.
Photo: A CIT class at the NYPD Police Academy (MARY ALTAFFER/AP PHOTO)