February 2008: Vol. 3, Issue 2
Contributor: Tony Salvatore
Montgomery County Emergency Services (MCES) was created in 1974 by a community coalition that saw jail diversion as a mental health system role. We exemplify the provider-based approach. MCES’ facility is a 73-bed nonprofit psychiatric hospital in
MCES was established in part as a 24/7 resource to police in situations involving psychiatric emergencies. Since 1975, we have offered crisis intervention training to police as the foundation of a comprehensive diversion strategy. Our program is designed for a setting with multiple jurisdictions. We serve a county with over 50 law enforcement agencies.
We see crisis intervention and the recognition of possible mental illness as basic law enforcement competencies. Our Crisis Intervention Specialist (CIS) Program educates police, correctional officers, probation/parole staff, and others to recognize and manage a mental health crisis. In 2007, 829 criminal justice personnel in PA and NJ took our 3-day course.
Our law enforcement training program has both classroom and field segments. Since 2003, NAMI’s “In Our Own Voice” program has been part of the training. Officers also spend time on our inpatient unit or join our Mobile Crisis Team in the community. We also offer “roll call trainings” and advanced training on special topics.
MCES is primarily a pre-booking program, but we are also known for “co-terminous diversion” because we try to have any charges dropped for individuals brought in by police, when appropriate. We intervene at multiple points in the criminal justice continuum, particularly at the county prison, as indicated by this extended “sequential intercept model:”
1. Police Contact –Through CIS-trained officers, a “cop card” (wallet-sized services summary), and on-site assistance to police, we direct at-risk individuals to MCES for psychiatric evaluations 24/7.
2. Initial Detention/Hearing –Criminal Justice Liaisons go to municipal lock-ups and district courts to arrange evaluations for individuals in custody.
3. Pre-trial/Trial –Liaisons seek dispositions involving treatment. We provide a mental health manual and education to judges, public defenders, and prosecutors.
4. Incarceration in Jail/Prison- The Forensic Transition Case Manager does case-finding at the county prison and advocates at court hearings for inmates with mental illness.
5. Re-entry from Prison – The Forensic Transition Case Manager does short-term follow-up after release from the county prison to facilitate community reintegration.
6. Community Supports – Outreach Specialists do interim case management and develop supports to strengthen prospects for recovery.
In 2007, MCES had over 1100 admissions after police referrals. There were 368 evaluations following police contact. Our mobile crisis team, which includes a psychiatric nurse, responded to 320 mental health calls at police request. The county mental health office funds our diversion staff. The Pew Charitable Trusts, the van Amerigen Foundation, the American Psychiatric Foundation, and the Patricia Kind Foundation have also supported the CIS Program.
As part of the ongoing development of our CIT Advocacy Toolkit, we are pleased to announce the release our Criminalization Facts. This fact sheet provides the basic information you will need to argue persuasively that criminalization of people with mental illnesses is costly for communities, a burden on police and corrections, and tragic for people with mental illnesses. It features sections on the high incidence of criminal justice involvement; the burden on corrections and police, and strategies that work to get people effective community services that prevent incarceration.
Tip: Local information is always more persuasive to decision-makers. If you have access to local information about the costs of incarcerating someone with mental illness, the cost of emergency psychiatric services, or tragedies involving people with mental illness and police or corrections, use this data to customize the fact sheet. Contact firstname.lastname@example.org for an editable version of Criminalization Facts.
The Georgia Crisis Intervention Team and NAMI Georgia will be hosting this year’s CIT National Conference, in
On January 29, New York Governor Eliot Spitzer signed into law a bill that will improve the conditions for prisoners with serious mental illness who are placed in “segregated housing units” or solitary confinement. All prisoners with serious mental illness will receive a psychiatric evaluation when they enter solitary confinement, and except under exceptional circumstances, will be removed to a less restrictive setting. Prisoners with serious mental illness who remain in solitary confinement will receive periodic screenings and enhanced programming or therapy. Prisoners who do not have a history of serious mental illness will receive less frequent mental health evaluations. The bill also prohibits, except in exceptional circumstances, feeding prisoners with serious mental illness in solitary confinement a restricted diet as a form of punishment. Finally, the bill authorizes the state Commission on Quality of Care and Advocacy for Persons with Disabilities to inspect and monitor prisons with inmates who have serious mental illnesses. To learn more, read a copy of the bill, or see Governor Spitzer’s press release.
A study published in the February issue of the journal Psychiatric Services found that CIT officers responding to calls involving a person with a mental illness in situations with a high potential for violence to self or others, rarely used force and almost always resolved the situation without injury. The study analyzed police records from incidents involving Las Vegas CIT officers. Although most calls involved some potential for violence – evidenced by threats of suicide, substance abuse, medication non-compliance, and other markers – officers only used force in 6% of incidents. Extreme use of force, including use of handcuffs, pepper spray, tasers or other less lethal weapons, was even rarer, and correlated to serious and extreme threats of violence. Finally, the study reported that CIT officers resolved most situations through hospitalization, and were less likely than other officers to arrest a person with mental illness. To learn more, visit the Psychiatric Services website, where you can view an abstract. You can also purchase the article for a fee. If you have any questions, contact Laura at email@example.com.
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US News and World Report
Read their recent article on mental health courts.
Please let us know what you think we should include in future editions of CIT in Action by emailing Laura Usher at firstname.lastname@example.org.
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