The first crisis intervention team (CIT) program was established in Memphis, Tenn. in 1988 after the shooting of a man living with a serious mental illness by a police officer. This tragedy prompted collaboration between the Memphis Police Department, NAMI Memphis, the University of Tennessee Medical School, the University of Memphis and mental health providers to improve the way police and the community respond to mental health crisis. The Memphis CIT program has achieved remarkable success, in large part because it has remained true to these strong local partnerships. Today, CIT has spread to more than 2800 communities in 45 states and the District of Columbia.
Two of the founders of the Memphis CIT program sat down with NAMI to reflect on the 25th anniversary of CIT and where the movement is going. Dr. Randy Dupont was the clinical director of emergency psychiatric services at the University of Tennessee Medical Center. Major Sam Cochran (ret.), was a lieutenant at the Memphis Police Department and the first coordinator of the Memphis CIT program. To learn more about their current work, visit the University of Memphis CIT Center website.
Sam Cochran: I was not really sure what NAMI was all about, and I was told only that they were to be considered as an important partner in this new endeavor we were calling crisis intervention team (CIT). The NAMI voice was present from the beginning. At every intersection, within the CIT process the NAMI message was clear and forthright: we want to help and our unity will change hearts. Initially, NAMI Memphis focused on safety concerns. To address these concerns we naturally developed a partnership between law enforcement, mental health providers and NAMI Memphis. The engagement of CIT as community partnerships were a natural fit for law enforcement. Nevertheless, CIT proved not only to work from an operational standpoint, but early results showed an improvement in safety.
Randy Dupont: CIT changed how I looked at police, advocates, family members and individuals with mental illness. I had not understood the powerful role they could have in assisting those in crisis. I had been trained in traditional mental health and did not understand how much family members and those with mental illness could bring about change. My eyes were really opened by CIT. It was the same thing with the police. I remember thinking, now I had 150 outreach workers in the community. This was fantastic. My experience with NAMI had been very limited before CIT.
It became obvious to me through CIT how much family members, those living with mental illness and police bring to the table.. This seems obvious now, but in 1988-1989 this was not so readily apparent.
What I understood was I had allies in the struggle to provide better services. In the police, I found outreach workers. With NAMI, there were individuals who cared and were willing to work with local government and service providers to make a change for the better. It was a very positive experience for me.
SC: From the very beginning it was clear that CIT was more than just a training program. Our society often wants to promote change through training. In most environments training can make a big difference. But CIT is more because it fights the stigma of mental illness. Stigma, or prejudice, is both powerful and harmful. CIT training can do a lot by changing the hearts of officers, so that they see people living with mental illness with their hearts and not with their eyes only. CIT officers must emerge from the 40 hour training on Friday with a new sense of responsibility and understanding of their role within the community.
When CIT officers join NAMI and serve on NAMI Affiliate boards and participate in NAMI Walks and routinely socially visit people who live with mental illness; when they plan a birthday party for a person living in a care home, or provide food at the end of the month when the Social Security check has not arrived but the need is present – what is this? It’s not training. CIT officers provide special service and care for individuals with mental illnesses because they developed personal relationships and because they are empowered by their communities to serve people with respect and empathy.
RD:No, to be honest, I did not imagine such success. When we started, CIT was a local program at the grassroots level, working without any government funding. The program was something that all of us thought could help us do our own work. It was a few years down the road before other communities got interested. I did not envision that we would have 2800 sites around the country. We really owe a lot to the hard work that many grassroots advocates have done to make a difference around the country.
SC: When we started, the CIT model looked do-able on paper. But it was a challenge to overcome the obstacles of fear and misinformation about just what partnerships meant or how they would impact the traditional ways of doing things. The early growing pains of CIT helped to shape an even stronger commitment from the partners.
We knew early on that CIT was more than training for Memphis, when law enforcement, mental health providers and NAMI Memphis joined to challenge state representatives to close our state hospital. The legislators asked, “Why are all these people together?” The answer to this question was that Memphis had given birth to a small revolution: a community united under the identity of a program called CIT.
RD: When CIT started, it had very profound implications for the people I was serving. I saw the difference in mental health services before and after CIT, and the change was dramatic to me. One day you are going it alone tackling one intervention at a time. When you move to a broader systems approach such as that advocated by CIT, you have all these allies that could make a difference and improve mental health services. It was very positive.
CIT works well together on all levels. Advocates get excited they can make a difference and change their whole community. It was very motivating for me to be part of that process and get to know some really impressive individuals throughout our country. CIT really changed the way I view mental health and it changed how I could help people
SC: CIT is a passion. CIT provides a way to address wrongs and set us on the right course. It is a meaningful pathway to understand mental illness. CIT allows us to provide service from the heart. It is the vision that guides us from the terrifying darkness of stigma to the light and hope of mental illness recovery.
SC: I hope communities stay committed to the core principles and embrace partnerships to sustain CIT. CIT should not to be created as a standalone program expecting to have or maintain magical powers to succeed where other system approaches have failed. CIT demands attention and serves best when mental health services and recovery are appropriately funded. The achievements and success of CIT are increased when each community commits to the long term goal of supporting mental health recovery. CIT is successful because it is a call to action to reestablish the purpose of people living as a community – a better quality of life for everyone.
NAMI has always had a vital role in nurturing community ownership of CIT so that it is more than just training. CIT is strong and will remain strong by standing with NAMI members and other great community partners in commitment to appropriate services with dignity.
RD:So far, I am impressed with the many people who make individual contributions to CIT. CIT requires individual leadership within law enforcement, the advocacy community and mental health professionals in order to work well. This individual initiative is critical to the success of CIT.
In terms of where CIT is going, there are things we need to face. There is a danger that CIT has become so popular that some want to use the name without the hard work and networking required by the model. From a research perspective we need to gain an understanding of how different parts of the model contribute to the success of CIT. There are lots of ingredients in CIT: volunteer officers, 40 hour training, new procedures and improved interaction with the community. All of those are important, but we need to better understand how each part contributes to positive change.
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