Improving Responses to 

People with Mental Illnesses

Tailoring Law Enforcement 

Initiatives to Individual Jurisdictions

Bureau of Justice Assistance U.S. Department of Justice

Improving Responses to 

People with Mental Illnesses

Tailoring Law Enforcement 

Initiatives to Individual Jurisdictions

A report prepared by the

Council of State Governments Justice Center

and the Police Executive Research Forum

for the

Bureau of Justice Assistance

Office of Justice Programs

U.S. Department of Justice

Melissa Reuland

Laura Draper

Blake Norton
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 Justice Assistance. 

The Bureau of Justice Assistance is a component of the Office of Justice Programs, which also includes the 

Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency 

Prevention, and the Office for Victims of Crime. The opinions and findings in this document do not necessarily 

represent the official position or policies of the United States Department of Justice, the members of the 

Council of State Governments, or the Police Executive Research Forum. 

The Bureau of Justice Assistance 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. 

Websites and sources referenced in this publication provided useful information at the time of this writing. 

The authors do not necessarily endorse the information of the sponsoring organization or other materials 

from these sources.

Council of State Governments Justice Center, New York 10005

© 2010 by the Council of State Governments Justice Center

Cover based on design by Nancy Kapp & Company. Interior design by David Williams.
Contents

Acknowledgments v

Introduction vii

Section I—Step by Step: The Program Design Process 1

Step 1: Understand the problem 3

Step 2: Articulate program goals and objectives 6

Step 3: Identify data-collection procedures 

needed to revise and evaluate the program 7

Step 4: Detail jurisdictional characteristics and 

their influence on program responses 9

Step 5: Establish response protocols 11

Step 6: Determine training requirements 15

Step 7: Prepare for program evaluation 17

Section II—From the Field: Program Design in Action 19

Tailoring Specialized Policing Response Programs

to Specific Problems 19

Tailoring Specialized Policing Response Programs to

Jurisdictional Characteristics 34

Appendix A: Site Visit Information 45

Appendix B: Document Development 49

Appendix C: Program Design Worksheet 51

Acknowledgments v

Acknowledgments

This report could not have been written without the leadership and support of the Bureau of 

Justice Assistance (BJA), Office of Justice Programs, U.S. Department of Justice, particularly 

from Ruby Qazilbash, Senior Policy Advisor for Substance Abuse and Mental Health, and 

Rebecca Rose, Policy Advisor for Substance Abuse and Mental Health. They expertly guided 

this document from start to finish.

The law enforcement and mental health professionals involved in each of the site visits 

provided the substance and “lessons learned” that make this report of true value to the 

field. Their commitment to improving the law enforcement response to people with mental 

illnesses is tremendous, and their willingness to share their experiences has resulted in a 

practical and user-friendly publication. Thanks are due to all those who met with the Council 

of State Governments (CSG) Justice Center project staff on site, and provided feedback on the 

document during various stages of its development. Special thanks go to the representative 

from each jurisdiction who helped coordinate each visit and scheduled the interviews with 

local stakeholders:*

• Victoria Cochran, Virginia State Coordinator for Criminal Justice and Mental Health 

Initiatives

• Deputy Chief Dottie Davis, Director of Training, Fort Wayne (Ind.) Police Department

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

• Sergeant Michael Yohe, CIT Coordinator, Akron (Ohio) Police Department

(A complete list of contributors, by jurisdiction, can be found in appendix A.)

There are also many agency representatives who participated in informative—and 

sometimes lengthy—phone interviews, providing project staff with details about how they 

tailored their law enforcement response program to often complex circumstances and 

demands. These initial interviews, involving key personnel from the following departments, 

provided a wealth of information, and assisted in the planning and conceptualization of the 

project.

• Baltimore County (Md.) Police Department

• Birmingham (Ala.) Police Department

• City of Lorain (Ohio) Police Department

• Fort Lauderdale (Fla.) Police Department

• Houston (Tex.) Police Department

• Jackson County (Mo.) Sheriff’s Office

• Jacksonville (Fla.) Sheriff’s Office

• Kansas City (Mo.) Police Department

*Representatives’ titles and agency affiliations reflect the positions they held at the time this document was 

published, which may differ from titles listed in appendix A.
vi Tailoring Law Enforcement Initiatives to Individual Jurisdictions

• Lees Summit (Mo.) Police Department

• Lincoln (Nebr.) Police Department

• Long Beach (Calif.) Police Department

• Montgomery County (Md.) Police Department

• New London (Conn.) Police Department

• Portland (Ore.) Police Bureau

• Portland (Maine) Police Department

• San Diego (Calif.) City Police and County Sheriff’s Department

The authors thank Justice Center Communications Director Martha Plotkin, Director 

Mike Thompson, and Health Systems and Services Policy Director Fred Osher for their 

insights in helping shape the scope and direction of this publication. Communications 

Deputy Director Regina L. Davis also contributed her well-honed editing skills. In addition, 

the authors appreciate the ongoing support that the Police Executive Research Forum’s 

Executive Director, Chuck Wexler, has lent this project and so many that affect the most 

vulnerable individuals who come into contact with law enforcement.
Introduction vii

Introduction

A growing number of law enforcement agencies have partnered with mental health agencies 

and community groups to design and implement innovative programs to improve encounters 

involving people with mental illnesses. These “specialized policing responses” (SPRs) are 

designed to produce better outcomes from these encounters by training responders to use 

crisis de-escalation strategies and prioritize treatment over incarceration when appropriate.1

Effective SPRs share many common features, but programs also differ in some important 

ways. These programmatic variations generally stem from a community’s unique needs, 

opportunities, and limitations. For example, officers in rural areas may have difficulty 

connecting people to a full range of mental health services, whereas officers in large urban 

areas may spend hours out of service trying to transport people to mental health facilities 

through traffic-congested areas. Some jurisdictions may spend tremendous resources 

responding repeatedly to a small number of locations or individuals. Other communities may 

face significant concerns about responding appropriately to particular groups of individuals, 

such as people with mental illnesses who are homeless.

1. There has been a trend toward categorizing any response in which law enforcement plays a central role in 

addressing people with mental illnesses as a “crisis intervention team (CIT)” approach. To avoid confusion, this 

publication refers to all law enforcement-based responses as “specialized policing responses” or SPRs (pronounced 

spurs). The term encompasses both “CIT “and “co-responder” approaches. Those terms can then be preserved to 

describe accurately the scope and nature of those models. 

Different Jurisdictions,

Different Program Models

Two of the most common law enforcement-based specialized response programs are the Crisis 

Intervention Team (CIT) model and the co-responder model. Each program model was developed 

based on a jurisdiction’s unique circumstances, reflecting the need for a flexible decisionmaking process.

Memphis (Tenn.) police leaders, mental health professionals and advocates, city hall 

officials, and other key stakeholders were spurred to action following a tragic incident in which 

an officer killed a person with a mental illness. In response, the Memphis Police Department 

established the first law enforcement-based CIT in 1988, which was designed to improve 

safety during these encounters by enhancing officers’ ability to de-escalate the situation and 

providing community-based treatment alternatives to incarceration.

Los Angeles and San Diego (Calif.) initiative leaders recognized that officers encountered 

many people with mental illnesses who were not engaged with treatments and services. 

To address this problem, law enforcement agencies collaborated with the mental health 

community to form teams in which officers and treatment professionals respond together at 

the scene to connect these individuals with community-based services more effectively.

spotlight
viii Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Law enforcement agencies have identified a variety of ways to respond that recognize the 

unique opportunities and limitations presented by each of their jurisdictions. Some agencies 

have replicated existing models from other jurisdictions—such as the Memphis CIT Model—

to improve their responses to people with mental illnesses. Other agencies have determined 

that specific community characteristics and law enforcement resources (for example, the 

lack of a single mental health facility or the tremendous size of a policing agency) require 

adaptations and additions to existing models—such as implementing a mental health 

outreach team in addition to an existing CIT program. 

To determine the best possible response model that will meet local needs, each 

jurisdiction should work through a program design process. This is not to say that they 

should reinvent the wheel, but rather they should not skip the critical program planning and 

development steps that ensure a program will reflect their unique community characteristics. 

Program design decisions should be made in the context of a collaborative planning process 

that includes a wide variety of stakeholders—a practice that most communities committed 

to specialized responses undertake.2 Beyond a commitment to collaboration, however, little 

is known about the steps law enforcement professionals and community members take to 

tailor other jurisdictions’ models to their own distinct problems and circumstances. This 

publication addresses that gap and provides guidance for jurisdictions that want to improve 

their law enforcement interactions with people who have mental illnesses.

About this Report

This report is the result of a project supported by the Bureau of Justice Assistance (BJA), 

U.S. Department of Justice. It explores the program design process, including detailed 

examples from several communities from across the country.3 It is meant to assist initiative 

leaders and agents of change who want to select or adapt program features from models 

that will be most effective in their communities. To ensure that this material has practical 

value, staff members from the Council of State Governments (CSG) Justice Center and the 

Police Executive Research Forum (PERF) visited four jurisdictions with extensive experience 

with SPRs to examine their decision-making and program development processes (selected 

based on a range of characteristics such as diverse objectives, jurisdiction size, and program 

model type).4 During each visit, project staff interviewed relevant stakeholders and observed 

2. Throughout this document, the term “stakeholders” is used to describe the diverse group of individuals 

affected by law enforcement encounters with people with mental illnesses, such as criminal justice and mental 

health professionals; myriad other service providers, including substance abuse counselors and housing 

professionals; people with mental illnesses (sometimes referred to as “consumers”) and their loved ones; crime 

victims; and other community representatives.

3. The examples included in this guide reflect various types of efforts that involve partnerships, programs, 

or practices for other communities to consider as they develop responses to people with mental illnesses. By 

highlighting this sampling of approaches, however, the authors are not necessarily promoting them as “best 

practices.”

4. For information on when the site visits were conducted and the personnel interviewed, see appendix A. 

This document also includes program examples from several other jurisdictions interviewed but not visited for 

this project, as well as several communities that have received grants through BJA’s Justice and Mental Health 

Collaboration Program (JMHCP). See www.ojp.usdoj.gov/BJA/grant/JMHCprogram.html for more information 

about JMHCP. 
Introduction ix

initiative activities.5 The four jurisdictions selected were Akron, Ohio; Fort Wayne, Ind.; Los 

Angeles, Calif.; and New River Valley, Va.

This report is divided into two sections: 1) Step by Step: The Program Design Process,

and 2) From the Field: Program Design in Action. The first section articulates the seven steps 

involved in shaping a program that best address a jurisdiction’s distinct resources and needs, 

and within each step provides questions to help guide the planning process. This section is 

5. Some practitioners are concerned that law enforcement not just conduct “programs” that are a discrete set of 

activities, instead stressing that agencies should develop broader “initiatives” in which an agency engages in a 

comprehensive effort that includes meaningful partnerships with the community and other agencies. Because 

practitioners in the field used these terms interchangeably in interviews, this report also uses both to refer to 

efforts to improve responses to people with mental illnesses and instead qualifies or describes the level of agency 

engagement and commitment from a community.

6. The fourteen law enforcement agencies that comprise the New River Valley (NRV) CIT are the Blacksburg 

Police Department, Christiansburg Police Department, Dublin Police Department, Floyd County Sheriff’s Office, 

Giles County Sheriff’s Office, Montgomery County Sheriff’s Office, Narrows Police Department, Pearisburg Police 

Department, Pulaski Police Department, Pulaski County Sheriff’s Office, Radford City Police Department, Radford 

City Sheriff’s Office, Radford University Police Department, and Virginia Tech Police Department.

About the Four Sites

Akron (Ohio) provides an example of a program that has remained true to the Memphis 

model of a Crisis Intervention Team (CIT), transplanting it to a new jurisdiction. This agency 

has collected a substantial amount of data, which has shown this program to be an effective 

solution to its jurisdictional needs. Agency representatives identified the need to augment CIT 

with follow-up program activities to address a broader range of problems in their jurisdiction. 

Fort Wayne (Ind.) operates a traditional CIT program with a focus on schools and 

juveniles. School Resource Officers (SROs) are trained to recognize and respond to a range of 

self-destructive behaviors (such as self-mutilation), and CIT officers coordinate with school 

administrators to identify youth who would be best served by mental health services rather 

than the juvenile justice system. Data collection processes are advanced and thorough, which 

allows program policymakers to evaluate the initiative’s progress.

Los Angeles (Calif.) has implemented a wide variety of adaptations to address the unique 

needs of its jurisdiction, focusing on a co-responder model, while incorporating elements of 

the CIT model into patrol operations, as well as creating a new program focusing on a priority 

population. Their experience illustrates the difficulties some large jurisdictions have had in 

implementing the CIT model citywide. Due to its sheer size, both in area and in population, 

the CIT approach alone did not effectively address the community’s problems. In response, the 

department believes it developed a more robust and multifaceted strategy. 

New River Valley (Va.) represents a rural, multi-jurisdictional CIT program that includes 

fourteen different law enforcement agencies contained in four counties and one city.6

The challenges facing these non-urban communities and the state law requiring that law 

enforcement take custody of a person meeting the criteria for an emergency mental health 

assessment have led to the need for several adaptations to the CIT model.

For more information on how these sites were selected, see appendix B.

spotlight
x Tailoring Law Enforcement Initiatives to Individual Jurisdictions

7. Readers are encouraged to review Improving Responses to People with Mental Illnesses: The Essential Elements of 

a Specialized Law Enforcement-Based Program to better understand how program design and decision making fit 

within a broader context. To download a copy, visit www.consensusproject.org/issue_areas/law-enforcement.

8. The project and publication were completed as part of BJA’s Law Enforcement/Mental Health Partnership 

Program. The resources developed as part of this suite of materials are available for free download at the law 

enforcement issues page on the Justice Center’s Consensus Project website (www.consensusproject.org). 

9. The ten essential elements presented in this document are Collaborative Planning and Implementation; 

Program Design; Specialized Training; Call-Taker and Dispatcher Protocols; Stabilization, Observation, and 

Disposition; Transportation and Custodial Transfer; Information Exchange and Confidentiality; Treatment, 

Supports, and Services; Organizational Support; and Program Evaluation and Sustainability.

most useful for policymakers and practitioners interested in learning how to design or revise 

a program—whether it is a CIT, a co-responder model, or some combination or variation of 

these models—that takes into full account the specific factors that drive their jurisdiction’s 

problems associated with law enforcement interactions with people who have mental 

illnesses. 

The second section provides two overview charts—one about problems that affect 

program design and the other about jurisdiction characteristics that can affect initiative plans. 

It also provides specific examples that illustrate how program design processes are translated 

into activities in the field, drawing on information provided during interviews and site visits. 

It describes how program elements are tailored to a jurisdiction’s problems and specific 

characteristics when implemented. 

The information collected from the four sites reveals a blurring of the two main models. 

In some cases, it is not possible to use the terms “CIT” or “co-responder” to describe the 

entirety of a jurisdiction’s responses; communities are now implementing a combination of 

both approaches. This section will help individuals interested in learning more about how 

other agencies throughout the country have navigated the program design process to develop 

these evolving initiatives.

As discussed more fully below, this report delves into some of the other ten “essential 

elements” of a successful SPR to people with mental illnesses that are identified and outlined 

in a previous publication.7 Whenever applicable, references to these elements are highlighted 

in the text. The material that follows also includes sidebar articles on related topics that often 

include references to additional sources of information.

Related Resources

This publication is just one in a series that addresses how law enforcement responds to 

people with mental illnesses. The Justice Center, in partnership with PERF and with support 

from BJA, has developed a collection of resources for law enforcement practitioners and 

their community partners.8 The centerpiece of the Improving Responses to People with Mental 

Illnesses suite of materials is the publication, The Essential Elements of a Law Enforcement-Based 

Program.

9 The other documents build on this essential elements publication. For example, 

one of the ten essential elements describes the need for specialized officer training that is 

tailored to the law enforcement audience. It is a very concise description of why training 

is needed and highlights some key challenges to overcome. Another publication, Strategies 

for Effective Law Enforcement Training, explores these training issues in greater depth and 
Introduction xi

raises additional matters that must be considered in training law enforcement officers. This 

document’s focus on tailoring specialized responses provides a similar level of discussion 

and guidance for readers who want to drill down to the details and implementation options 

for the essential element that encourages thoughtful, collaborative program design. These 

written materials are complemented by web-based information on statewide efforts to 

coordinate law enforcement responses and by an online Local Programs Database.10

10. The Local Programs Database, formerly referred to as the Criminal Justice/Mental Health Information 

Network (InfoNet), was made possible through the leadership, support, and collaboration of key federal 

agencies and private foundations, including the Bureau of Justice Assistance (BJA) and the National Institute of 

Corrections (NIC). The database was created to foster peer-to-peer learning among agencies across the country. 

The database is interactive and entries include contact information to facilitate information sharing, as well 

as easily searchable fields on key topics. The database is available through the Consensus Project website at 

www.consensusproject.org and can be searched for information on other programs or accessed to create a new 

program profile.

11. This and other elements reflect a consensus of experts, including a broad range of policymakers, 

practitioners, advocates, and researchers, whose recommendations are captured in the Essential Elements report.

Program Design11

The planning committee designs a specialized law enforcement-based 

program to address the root causes of the problems that are impeding 

improved responses to people with mental illnesses and makes the most 

of available resources.

Essential 

Element

2

Step by Step: The Program Design Process 1

Section I

Step by Step: 

The Program Design Process

Designing a program specific to a community’s unique needs is a complex process. 

Identifying and implementing a collaborative partnership is the first hurdle, but once 

stakeholders are involved and committed to the issue, the question remains, “What next?” 

It is critical that a planning committee (and its program coordination group) develop 

a strong level of collaboration among stakeholders, yet the process can be fraught with 

significant challenges. Personnel from the four featured sites shared how they have 

successfully engaged people who are vested in the outcomes of law enforcement interactions 

involving people with mental illnesses and established lasting frameworks to maintain their 

programs’ integrity. The keys to their success include the following:

• Gain the support of law enforcement leaders through the involvement of other law 

enforcement leaders. In deciding whether to participate in the New River Valley CIT 

program, the Chief of the Pearisburg (Va.) Police Department was influenced by both 

the chief law enforcement executive in Radford (Va.) and Major Sam Cochran, the 

former CIT Coordinator for the Memphis (Tenn.) Police Department, who were each 

able to explain—from one law enforcement official to another—the importance and 

benefits of specialized responses to people with mental illnesses. 

Collaborative Planning and Implementation 

Organizations and individuals representing a wide range of 

disciplines and perspectives and with a strong interest in improving 

law enforcement encounters with people with mental illnesses work 

together in one or more groups to determine the response program’s 

characteristics and guide implementation efforts.

Keys to Collaboration

The planning committee is composed of leaders from each of the stakeholder 

agencies who have operational decision-making authority and community 

representatives. This executive-level committee should examine the nature of 

the problem and help determine the program’s objectives and design. 

The program coordination group is made up of staff members from 

stakeholder agencies. This group should oversee officer training, measure 

the program’s progress toward achieving stated goals, and resolve ongoing 

challenges to program effectiveness.

In some jurisdictions, the two bodies may be the same—particularly those 

with small agencies, in rural areas, or with limited resources. 

Essential 

Element

1
2 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

• Develop a subcommittee structure within the larger planning committee or program 

coordination group to support targeted issue areas and make collaboration more 

efficient. In addition to their participation in a multidisciplinary coalition in the New 

River Valley CIT program, initiative planners developed a “Law Enforcement and Mental 

Health Services Coalition,” which meets quarterly to discuss mental health issues 

related specifically to law enforcement. In Fort Wayne (Ind.), a subcommittee composed 

of individuals from law enforcement, mental health, and advocacy meets separately to 

focus on training development and then to prepare and host training sessions several 

times each year. The training committee in Akron (Ohio), which meets twice yearly, 

manages the iterative process of refreshing the curriculum to ensure it reflects the most 

current policies and procedures. 

• Designate staff members to focus on accountability and to maintain connections among 

stakeholders in the collaboration. The planning committee can designate staff members 

in the program coordination group to manage the logistics of partnerships. Identified 

personnel can ensure that there is an emphasis on collaboration from the start of the 

program. 

• Exchange meaningful information to measure outcomes and foster necessary program 

changes. Stakeholders will be more likely to maintain their involvement if they find 

the meetings provide meaningful information and accomplish specific tasks. In Los 

Angeles, the police department shares information with its mental health advisory board 

about their use-of-force trends and reports, for example.

What Next, After Collaboration?

This section outlines seven key steps involved in the collaborative program design process. 

Each step includes a series of questions designed to help planning and coordination groups 

structure their discussions and advance their thinking about related issues.12

Step 1: Understand the problem

Step 2: Articulate program goals and objectives

Step 3: Identify data-collection procedures needed to revise and evaluate the program 

Step 4: Detail jurisdictional characteristics and their influence on program responses

Step 5: Establish response protocols

Step 6: Determine training requirements

Step 7: Prepare for program evaluation 

In each of the four jurisdictions—Akron, Fort Wayne, Los Angeles, and New River 

Valley—initiative leaders found that the challenges their community faced were inter-related, 

multilayered, and required similarly complex and nuanced responses. In addition, those 

12. For a worksheet that provides the questions that guide the design process without the narrative explanation, 

see appendix C. 
Step by Step: The Program Design Process 3

who had created programmatic responses found that it was an iterative process, rather than 

a simple linear approach. Accordingly, the steps recommended in this guide are designed to 

be revisited as needed to fine-tune efforts and remain responsive to conditions and resources 

in a jurisdiction. Program design does not end when the seven steps are complete, but rather 

requires an ongoing effort to evaluate and adjust program responses as the community’s 

landscape changes.

Step 1:

Understand the problem13

Program development is often initiated in reaction to a 

terrible tragedy in the community, impending litigation, or 

another event. Partners involved in the collaboration should 

start the program design process by researching and then 

moving beyond the initial impetus to develop a common 

and comprehensive understanding of the legal, clinical, 

and community circumstances that make it so challenging 

to effectively respond to people with mental illnesses 

encountered by law enforcement officers. 

It is important to stress from the outset that research 

does not support the stereotype that people with mental 

illnesses are more violent than individuals in the general 

population.14 Accordingly, police use of force is usually not 

needed. Yet even though the occurrence is infrequent for 

there to be law enforcement shootings involving people with 

mental illnesses, the impact of such events on the officer, 

the individual’s family, and the community—and even on 

other communities not directly involved—is profound and 

13. Gary Cordner’s report “People with Mental Illness” also emphasizes the need for decision-makers to 

understand the problem in their local community to design an effective response strategy. He provides detailed 

questions that planners should ask to better understand the impact of incidents, stakeholders, victims, 

offenders, and locations/times. Gary Cordner, “People with Mental Illness,” Problem-Oriented Guides for Police 

Problem-Specific Guides Series, Number 40, U.S. Department of Justice (Washington, DC: Office of Community 

Oriented Policing Services, 2006), www.popcenter.org/problems/mental_illness.

14. For a scholarly review, see A. Harris and A.J. Lurigio, “Mental illness and violence: A brief review of 

research and assessment strategies,” Aggressive and Violent Behavior 12(5) 2007: 542–51. Several large-scale 

research projects found a weak statistical association between mental illness and violence (M.C. Angermeyer, 

B. Cooper, and B.G. Link. “Mental disorder and violence: Results of epidemiological studies in the era of 

deinstitutionalization,” Social Psychiatry and Psychiatric Epidemiology 33(13) 1998: S1–S6). The association becomes 

stronger, however, when a person with a mental illness has a co-occurring substance use disorder and/or is not 

taking his or her medication (H.J. Steadman, E.P. Mulvey, J. Monahan, P.C. Robbins, P.S. Appelbaum, T. Grisso, 

L.H. Roth, and E. Silver, “Violence by people discharged from acute psychiatric inpatient facilities and by others in 

the same neighborhoods.” Archives of General Psychiatry 55 1998: 393–401; M.S. Swartz, J.W. Swanson, V.A. Hiday, 

R. Borum, H.R. Wagner, and B.J. Burns. “Violence and severe mental illness: The effects of substance abuse and 

nonadherence to medication,” American Journal of Psychiatry 155 1998: 226–31).

We ask ourselves, and other 

agencies ask, too, would these 

terrible incidents have happened 

[where someone is shot and 

killed] had this program been 

in place at that time? We paid 

a terrible price. Why would an 

agency choose to do otherwise? 

How could they see what has 

happened here and in LA County 

and knowingly choose not to do 

this program? It makes no sense 

to me.”

—Assistant Chief 

Earl Paysinger

Director, Office of Operations, 

Los Angeles (Calif.) Police Department
4 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

far-reaching. The following questions can prompt planners to investigate the scope and 

nature of the challenges officers face in incidents involving people with mental illnesses 

and design appropriate responses.

Question 1: What forces are driving current efforts to improve the law 

enforcement response to people with mental illnesses? 

Stakeholders should contribute their individual perspectives to answer this question. 

Law enforcement line staff may voice concern about the many challenges they face 

during encounters involving people with mental illnesses—many agree that these calls 

are often time-consuming and frustrating. Patrol officers may spend long periods of 

time attempting to link a person in crisis to an appropriate mental health resource, 

and also may find themselves responding repeatedly to the same individuals without 

seeing any improvement in the outcomes. From another perspective, consumers of 

mental health services and their families might identify the need for change because of 

the limited treatment and response options for people with mental illnesses at risk of 

criminal justice involvement. They may not have any other options when a loved one 

is in crisis, but are disappointed by the results of law enforcement engagement. Both 

stakeholder groups would likely agree that the person’s mental health and related calls 

for service are not improved through the more traditional interactions with police. It 

is important both to recognize the legitimacy of each argument and the need to reach 

consensus around the issues influencing the reasons for change. (Section II of this 

report provides more detail about the specific problems and the contributing factors 

that various jurisdictions have encountered.)

Question 2: What data can planning committee members examine to understand 

the factors influencing law enforcement responses to people with mental 

illnesses?

Effective program design hinges on accurately identifying the causes of the problems 

communities face. For example, if a community is responding to a tragic incident, 

stakeholders must explore the circumstances that led up to and occurred during the 

incident. They will also want to look for more systemic issues that go beyond those 

involved in the particular incident. This exploration may include interviews with the 

involved parties and a review of law enforcement and mental health system protocols 

and procedures (including response practices and training), as well as an assessment of 

resource gaps that may be hindering better responses to people with mental illnesses. 

Among the law enforcement data that should be considered when defining the 

scope and nature of the problem are the number and types of calls related to people 

with mental illnesses, duration of the responses, and related use-of-force information. 

It may be important to note whether officers are responding repeatedly to the same 

individuals and locations to determine if interventions are needed to produce better 

results. One option is to examine computer-aided dispatch (CAD) data. If possible, 

efforts should be made to understand outcomes of calls for service through forms used 

to track the disposition of calls. 
Step by Step: The Program Design Process 5

15. “Receiving psychiatric facilities” include all medical facilities that will receive, assess, and treat someone 

in a mental health crisis, including hospital emergency rooms, psychiatric hospitals, and crisis drop-off 

centers. Most medical information is protected under federal and state privacy laws. If stakeholders wish to 

examine protected health information during this process, they should take into account laws governing 

this information exchange. For an overview of the federal laws, see John Petrila, “Dispelling the Myths about 

Information Sharing between the Mental Health and Criminal Justice Systems,” National GAINS Center for 

Systemic Change for Justice-Involved People with Mental Illness (February 2007). Petrila also participated in a 

webinar, “HIPAA: Myths, Facts, and Cross-systems Collaboration” (March 23, 2009). The associated presentation 

is available at www.consensusproject.org/features/hipaappt.

Valuable information should also be gleaned about the mental health system 

response. For example, planners can review the number and type of admissions at 

the receiving psychiatric facilities, and gather feedback on this process from officers, 

mental health professionals, family members, and consumers that has been collected 

through focus groups, surveys, or interviews.15 Data should be collected on how long 

officers spend at the mental health facility and problems experienced in transferring 

custody as well. It is also important to catalog the types of services provided by 

community mental health centers and other providers, their availability, and their 

capacity to address the individuals’ needs. Together, this information can then inform 

needed changes in responses. 

(Problems that are related to community and agency characteristics, such as lack of 

mental health resources uncovered by cataloging the number and kind of available 

providers and their admission criteria, are addressed in Step 4: Question 2.) 

Question 3: What are the data limitations, and how can they be overcome? 

Stakeholders should identify the limitations of various data sources, such as the 

scant reporting on perceived mental illness in CAD databases or the failure of 

mental health intake records to account for the involvement of law enforcement. Law 

enforcement and community stakeholders should explore why officers may not be 

reporting encounters they resolve at the scene, what system limitations there are that 

make it difficult to capture relevant information when clearing a call or ending a field 

interaction, and other problems with gathering information on these interactions. 

Efforts should be made to resolve these issues and gain a better understanding of 

whether repeat calls for service, or particularly difficult incidents, center on a particular 

subgroup of individuals, such as people in a particular beat, men with substance abuse 

problems, or women who are homeless. 

A critical component of the program design process is to ensure that goals, 

objectives, policy and practice reforms, and measures of success are all data-driven 

and tailored to a particular jurisdiction’s distinctive needs. Because of problems with 

underreporting and other collection barriers mentioned previously, data should be 

interpreted with these limitations in mind. They are, however, still useful sources of 

information that provide a starting point for program design. To enhance the reliability 

of the information, stakeholders should consult multiple sources of data. 
6 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Step 2:

Articulate program goals and objectives

Once the collaborative planning group has a firm grasp on the challenges facing the 

community, they should establish the program’s goals and objectives. Program goals 

capture the “big picture” of the good that the effort is meant to achieve, whereas 

objectives outline program activities that, if achieved, would meet those goals. A shared 

statement of the program goals will advance the discussion around program design. The 

objectives will not only detail the mechanisms for achieving a program goal, but will 

also provide a framework for developing evaluation measures. Program planners should 

articulate realistic goals and objectives, and avoid terminology that suggests problems 

will be “eliminated” or that all individuals will benefit from improved responses. It is 

advisable to establish both short- and long-term goals and objectives to help ensure early 

successes and sustainability.

Question 1: What are the program’s overarching goals?

The program’s goals reflect the desired outcome of the initiative on the primary problems 

identified by the planning group and other stakeholders in the community. For example, 

if the community is responding to a tragic incident involving law enforcement and a 

person with mental illness, the program goals might include improving officer and 

community safety. The goals should be well-articulated in writing and shared among all 

partners and the community, and should be reviewed periodically. 

Other goals might include reducing arrests for minor offenses, lowering the number 

of repeat calls for service involving people with mental illnesses, decreasing the use 

of force by law enforcement, incurring fewer injuries among all involved at the scene, 

increasing the numbers of people diverted to mental health treatment when warranted, 

or cutting law enforcement agency costs. 

Question 2: What are the program’s objectives? 

Objectives capture the specific program activities needed to achieve the stated goals. For 

example, if stakeholders identify improved safety as the program goal, providing effective 

agency training on de-escalation will be a key program objective. Objectives should be as 

specific as possible. In this example, the objective could be to train a certain proportion of 

the primary and secondary responders or a particular subset of individuals.16 If the goal 

is to address strains on law enforcement resources, one objective might be reducing the 

amount of time officers spend attempting to link people with mental illnesses to mental 

health services to a target number (for example, 15–30 minutes). 

16. Examples that include specific numbers or percentages included in this section are not intended as 

recommendations, but are included only to highlight the value of setting specific goals within the agency 

to monitor improvement and to evaluate the extent to which the program is implemented. 
Step by Step: The Program Design Process 7

Step 3:

Identify data-collection procedures needed to revise 

and evaluate the program17

Once program goals and objectives are set, law enforcement and their partners can use 

them to identify what information they should collect and how they should collect it.18

Data collection practices should take into account both process and outcome measures. 

Evaluating a program’s process will allow coordinators to assess whether the proposed 

activities are being carried out (how many individuals were trained, how many calls 

were answered by an officer with training, and more) so planners can revise day-to-day 

program functioning and the reach of the initiative. It is also critical that the evaluation 

determine whether the activities are having the intended outcome (that is, the impact 

that planners hoped to achieve for people with mental illnesses, officers, and the 

community)—information needed not only to assess true advances, but also to secure 

funding and ensure program sustainability over time. 

Question 1: What data will be collected to measure whether goals and objectives 

have been achieved? 

Once goals and objectives have been articulated clearly, determining what information 

is required to measure them will be generally straightforward. For example, if a goal 

is to increase safety, an agency would want to collect data on injuries or deaths, use of 

force, and citizen complaints to see if that has been attained. If a related objective is to 

train all recruits, the agency or its partners will need to track the number of recruits 

who complete the curriculum or successfully pass a test. Most initiatives will want to 

address many of the issues raised previously that relate to using scarce law enforcement 

resources to better identify and safely serve people with mental illnesses—particularly 

those who should appropriately be diverted to the mental health system. Accordingly, 

the collaborative planning group and other stakeholders will want to collect data such as 

the frequency of calls for service involving people with mental illnesses, including how 

many are to the same individuals or locations; the types and frequency of disposition 

decisions; the percentage of calls that specially trained personnel handle and the portion 

that involve routine responses, and the duration of those responses; and any injuries 

or fatalities suffered during law enforcement encounters involving people with mental 

illnesses. 

17. Cordner’s “People with Mental Illness” provides additional information on measures that could be used to 

evaluate the effectiveness of the SPR. Cordner, “People with Mental Illness.” For a detailed guide to program 

evaluation, consult such resources as Richard A. Berk and Peter H. Rossi, Thinking about Program Evaluation 2

(Thousand Oaks, CA: Sage Publications, 1999); Robert H. Langworthy, ed. Measuring What Matters: Proceedings from 

the Policing Research Institute Meetings, (Washington, DC: U.S. Department of Justice, National Institute of Justice, 

1999); Kristin Ward, Susan Chibnall, and Robyn Harris. Measuring Excellence: Planning and Managing Evaluations of 

Law Enforcement Initiatives (Washington, DC: U.S. Department of Justice Office of Community Oriented Policing 

Services, 2007).

18. Law enforcement agencies may want to partner with a local college or university to assist with identifying 

what data to collect. Academic partners should be included from the beginning of the planning stages to provide 

guidance during this step.
8 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Question 2: What data collection strategies will be used? 

Many existing data sources—such as CAD data, 

Emergency Medical Services (EMS) logs, and 

Emergency Room records—can provide useful 

information. These data systems typically were 

designed, however, to capture information for purposes 

other than law enforcement/mental health program 

improvement or evaluation. As a result, specialized law 

enforcement-based programs almost always require 

collecting new information, and often from different 

sources or in novel ways. 

Collecting the necessary information has proven 

difficult for many agencies. Each of the four agencies 

featured in this report had varying levels of success 

capturing data consistently from both law enforcement 

officers and mental health providers. The two major 

limitations are 1) inconsistency in call identification 

and 2) paperwork noncompliance. Most agencies do not have a reliable method to label 

calls for service involving people with mental illnesses at the time of dispatch, nor an ability 

to update the codes in the CAD system retroactively to reflect new information relating 

to mental health status.19 In terms of noncompliance with record-keeping or reporting 

practices, law enforcement officers have an enormous amount of paperwork to complete for 

all incidents, particularly those involving serious crimes or arrests, and may feel that the time 

needed to complete an additional form is in conflict with their other policing duties. Both of 

these factors can result in missing or incomplete data in law enforcement systems. Mental 

health providers may also experience problems with trying to maintain updated, accurate 

information in their systems given their often overwhelming caseloads. Departments must 

be creative and persistent in overcoming these challenges. 

19. The majority of police action related to people with mental illnesses in the four sites studied was based on 

responding to calls for service rather than incidents observed during the course of routine patrol. 

Every time there is a CIT 

encounter, there is a stat 

sheet completed. This 

is a police department 

document, which can be 

shared internally and also 

with mental health partners. 

These sheets are used to 

identify problems so we can 

address them.” 

—Dr. Mark Munetz

Chief Clinical Officer, Summit 

County (Ohio) Alcohol, Drug 

Addiction and Mental Health 

Services Board

PROGRAM EXAMPLE: Addressing barriers to data collection, Philadelphia (Pa.)

In 2006, Philadelphia received a Justice and Mental Health Collaboration Program (JMHCP) 

grant from the Bureau of Justice Assistance. Initiative leaders decided to use this funding to 

plan and implement a CIT program in the Philadelphia Police Department—pilot-testing the 

program in a single division and addressing any challenges before expanding it departmentwide.

According to coalition members, one of the main difficulties the planners faced was obtaining information directly from the CIT officers about their encounters with people with mental 

illnesses. In response, they decided to change their data-reporting system from a paper-based 

system to a call-in system. At this writing, officers call the CIT coordinator to complete the 

necessary form by phone, and then the coordinator collects and files the reports.

For more information about Philadelphia’s program, see the program entry in the Local 

Programs Database available at www.consensusproject.org.
Step by Step: The Program Design Process 9

Step 4:

Detail jurisdictional characteristics and their influence 

on program responses 

For this discussion, “jurisdictional characteristics” refers to those aspects of a community 

that are difficult to change, often requiring long-term efforts. Based on information 

gathered during the site visits, project staff found these characteristics fall into four 

categories relating to 1) the law enforcement agency, 2) the mental health system, 

3) state laws, and 4) geography and demography. Each of these categories should be 

considered when designing a program. 

Question 1: What characteristics of the law enforcement agency are relevant in 

planning a specialized response to people with mental illnesses? 

The planning group and stakeholders should consider the 

following during the design stage: 

• Agency resources, which include staffing levels, data 

management structures, training expertise and capacity, 

and availability of less-lethal technologies. 

• Relevant policies and regulations, such as use-of-force 

guidelines, discretion in making arrests, policies on 

diversion, reporting requirements, information-sharing 

policies, and requirements for handcuffing during 

custodial transport. 

• Leadership styles, which may dictate the number of 

officers a program seeks to train, either focusing on a 

small self-selecting group or providing training to an entire 

department. Some law enforcement executives believe 

a subset of officers must become “specialists” who are 

dedicated to particular areas of expertise (such as domestic 

violence) because the additional information they obtain 

will help them respond to those situations more effectively. 

Other chiefs or agency executives believe all officers 

should be prepared to respond to all situations they will 

encounter. Leadership must believe there is a compelling 

need to prioritize limited resources to address this issue. 

And they must be willing to designate someone within the 

agency to help provide oversight and support to the effort, 

to work collaboratively with the mental health community, 

and to garner support among policymakers to ensure 

sustainability. The agency should have leaders who are 

willing to even reconsider officer evaluation criteria that is 

Working on the CIT 

Outreach Team provides 

great satisfaction, but it 

should remain voluntary—

it requires a certain kind 

of officer who is internally 

motivated.” 

—Officer Forrest Kappler

CIT Officer, Akron (Ohio) 

Police Department

I talk about the 

three Cs of program 

success: compassion, 

constitutionality, and 

consistency. Compassion 

is brought by people 

who want to be [in a 

specialized assignment]. 

Constitutionality and 

consistency are greatly 

enhanced when the 

department provides 

resources.”

—Chief William Bratton

Los Angeles (Calif.) 

Police Department
10 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

more in keeping with community policing principles—in which officers are reviewed 

for their problem-solving and de-escalation skills instead of the number of arrests they 

make.

Question 2: What mental health system characteristics are relevant in 

planning a specialized response to people with mental illnesses? 

As part of the program design process, stakeholders should catalog available mental health 

resources in the community, identify the criteria for or any restrictions to accessing them, 

and describe their capacity and availability. For example, if there are no twenty-four-hour 

facilities to receive people with mental illnesses except emergency rooms, and officers are 

required to wait hours with the individual to be seen, alternatives can be explored. And 

if facilities will only accept individuals who meet specific eligibility criteria, such as only 

individuals not under the influence of drugs or alcohol, it becomes clear that other options 

must be indentified to support officers when they encounter these individuals.

The planning group and relevant stakeholders should then identify service gaps. 

Community mental health resources might include emergency departments, inpatient 

and outpatient treatment programs, crisis response services, emergency receiving centers, 

family support programs, telephone hotlines, clubhouses and other peer-to-peer supports, 

and ancillary services such as housing assistance and income and entitlement support.20

Throughout this review, the planning group should work with policymakers and other key 

groups to examine the structure of the mental health system and understand variations 

in catchment areas (municipal vs. county) and revenue sources (private vs. public). These 

variations may affect law enforcement responses by impacting where officers can transport a 

person in crisis.

 Beyond identifying available mental health resources, stakeholders should become 

familiar with the avenues available to law enforcement officers to access these services 

(whether in person, by telephone, or through a referral mechanism), understand the 

requirements for medical clearance, and clarify existing protocols or procedures for 

voluntary and involuntary admissions for mental health evaluations and assessments.

Question 3: What state laws are relevant in planning a specialized response to 

people with mental illnesses? 

State laws can address a range of issues relating to the law enforcement response. For 

example, they can mandate law enforcement training and dictate the criteria that must be 

met and the protocols that must be followed for an emergency mental health evaluation. 

Local law enforcement officers can play a critical role in this process. In Nebraska, for 

20. According to the International Association of Clubhouse Development, a clubhouse is “a community 

intentionally organized to support individuals living with the effects of mental illness. Through 

participation in a clubhouse people are given the opportunities to rejoin the worlds of friendships, family, 

important work, employment, education, and to access the services and supports they may individually 

need.” More information is available at www.iccd.org.
Step by Step: The Program Design Process 11

example, a sworn law enforcement officer is required to determine if a person meets the 

criteria for involuntary emergency evaluation, to maintain custody of the person, and to 

transport the person to the mental health receiving facility. In other states, a magistrate 

or clinician might be required to make the commitment determination. States may have 

outpatient commitment laws that can be enforced prior to consumers becoming dangerous 

to themselves or others. Consumers may develop advance directives that provide instructions 

for how they wish to be treated if they decompensate. These mandates and regulations 

can present both an opportunity and a burden on law enforcement officers, and should be 

considered fully by planners. 

Question 4: What demographic and geographic community characteristics are 

relevant in planning a specialized response to people with mental illnesses? 

A jurisdiction’s population, population density, land area, and crime patterns can present 

important constraints or benefits to developing specialized response programs. For example, 

a jurisdiction whose only emergency mental health resources are located far from particular 

law enforcement beats or districts will require officers to spend long periods out of service 

transporting individuals, particularly if they have to pass through densely populated, trafficcongested areas. Rural and urban areas may have very different problems that will affect 

dispatch and response times. Some rural areas may be dependent on only phone access to 

mental health professionals who can direct emergency evaluations. Further, an area that is 

populated primarily by seniors may have very different needs than those that are generally 

young families with children, or that have a large number of homeless individuals. Although 

jurisdictions of every size can struggle with inadequate resources (especially when budget 

cuts directly impact state and community mental health services), these considerations 

should be addressed carefully when shaping a law enforcement initiative.

Step 5:

Establish response protocols

At this stage of design, the planning group will understand how law enforcement, mental 

health, and other community-based providers are currently responding to people with 

mental illnesses who are at risk of criminal justice involvement. Based on the community’s 

characteristics, it should be possible to see how these can be better integrated and shaped to 

address identified problem areas and service gaps. Program development decisions at this 

point in the process should focus on which law enforcement and mental health responses are 

needed, both individually and collectively, and what resources are needed to support them. 

Question 1: What law enforcement responses are necessary? 

There are three main categories of law enforcement first-responder activities that require 

consideration and planning—call-taker and dispatcher protocols; on-scene activities 
12 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

(stabilization, observation, and disposition); and 

transportation and custodial transfer.21 Planners 

must decide which personnel will serve as primary 

responders to scenes involving a person in a mental 

health crisis, and how they will be dispatched. Based 

on the review of the law enforcement/mental health 

problems and community characteristics, they may 

choose to train a subset of officers for this responsibility, 

train all officers, or pair officers with mental health 

clinicians or caseworkers. In addition to these activities, 

planners may also choose to involve law enforcement 

officers in follow-up activities not generated by a call for 

service. 

Question 2: What mental health system responses are necessary? 

Mental health personnel may be involved in a variety of ways, including providing 

information to dispatchers, co-responding to calls for service involving a person with mental 

illness, acting as a remote resource if no on-scene professional can be available, helping to 

train or cross-train personnel, and coordinating a follow-up effort, particularly with people 

There are immeasurable 

benefits to officers who 

travel with mental health 

professionals on the SMART 

teams both for the officers 

and the clinicians in terms 

of information exchange and 

awareness.” 

—Commander Harlan Ward

Assistant Commanding Officer of 

Valley Bureau, Los Angeles (Calif.) 

Police Department

Essential Element 4—Call-Taker and Dispatcher 

Protocols

Call takers and dispatchers identify critical information to direct calls 

to the appropriate responders, inform the law enforcement response, 

and record this information for analysis and as a reference for future calls 

for service.

Essential Element 5—Stabilization, Observation, and 

Disposition

Specialized law enforcement responders de-escalate and observe the nature of 

incidents in which mental illness may be a factor using tactics focused on safety. 

Drawing on their understanding and knowledge of relevant laws and available 

resources, officers then determine the appropriate disposition.

Essential Element 6—Transportation and Custodial Transfer

Law enforcement responders transport and transfer custody of the person with 

a mental illness in a safe and sensitive manner that supports the individual’s 

efficient access to mental health services and the officers’ timely return to duty.

Essential 

Elements

4–6

21. Each of these three categories represents one of the ten elements in The Essential Elements of a Specialized 

Law Enforcement-Based Response. For more information, see http://consensusproject.org/jc_publications/

le-essentialelements.pdf.
Step by Step: The Program Design Process 13

identified as high utilizers of emergency mental health services. 

Collaboration for certain activities may be best achieved through 

co-location of law enforcement and mental health coordinators 

or such mechanisms as merged or integrated databases that are 

consistent with privacy laws. 

As the Justice Center’s Essential Elements publication 

indicates, individuals with mental illnesses often require an 

array of services and supports, which can include medications, 

counseling, substance abuse treatment, income supports and 

government entitlements, housing, crisis services, peer supports, 

case management, and inpatient treatment. Planners of the SPR 

program should anticipate the treatment needs of the individuals 

with whom law enforcement will come in contact and work with 

service providers in the community to ensure these needs can be 

met and coordinated.

Because many individuals with mental illnesses who come into contact with law 

enforcement have co-occurring substance use disorders, the availability of integrated 

treatment approaches is essential to achieve clinical and public safety objectives. 

Accordingly, stakeholders should consider how the program can help connect individuals 

with co-occurring disorders to integrated treatment and should advocate for greater access 

to this and other evidence-based practices.22 Histories of trauma and post-traumatic 

stress disorder are common in criminal justice-involved populations. As such, both the 

on-scene response of law enforcement and subsequent clinical responses must be traumainformed. Planners should pay special attention to the service needs of racial and ethnic 

minorities and women by making culturally competent and gender-sensitive services 

available to the extent possible.

Stakeholders should also identify ways to improve the efficiency of access to needed 

services. This may entail broader system changes and agreements, such as streamlining 

the custody transfer process at a mental health intake facility through memoranda of 

agreement (MOAs) and revised protocols. Law enforcement should have within easy 

reach twenty-four-hour drop-off facilities or emergency room(s) designated to expedite the 

transfer of custody to ensure the individual receives swift mental health services and allow 

officers to return quickly to duty.23

22. Evidence-based practices (EBPs) are mental health service interventions for which consistent scientific 

evidence demonstrates their ability to improve consumer outcomes. 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): 179–82. Other EBPs include assertive community 

treatment, psychotropic medications, supported employment, family psychoeducation, and illness selfmanagement, see Fred C. Osher and Henry J. Steadman: “Adapting Evidence-Based Practices for Persons with 

Mental Illness Involved with the Criminal Justice System,” Psychiatric Services 11 (2007), 1472–78.

23. For more information about the role of specialized crisis response sites, see Henry J. Steadman, Kristin A. 

Stainbrook, Patricia Griffin, Jeffrey Draine, Randy Dupont, and Cathy Horey. “A Specialized Crisis Response Site 

as a Core Element of Police-Based Diversion Programs,” Psychiatric Services 52 (2001): 219–22. 

We need to create drop-off 

stations at the hospital to 

receive people in crisis. This 

requires not only trained law 

enforcement staff, but also 

an appropriate space—a 

space where we can safely 

manage the behavior of 

people who are out of 

control.” 

—Marie Moon Painter

Clinical Team Leader for 

CONNECT, Carilion St. Albans 

Behavioral Health, Virginia
14 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Question 3: What other responses or resources are necessary? 

While law enforcement agencies and mental health professionals can provide the majority of 

responses that the planners will prioritize, other partner organizations and their resources 

may be required to address the problem faced by the community. For example, consumeror advocate-led organizations, such as clubhouses, can provide essential support to people 

in crisis and supplement limited mental health resources. Non-law enforcement criminal 

justice professionals, such as judges, magistrates, and jail personnel, can play an important 

role in identifying and assessing individuals who may be in need of emergency mental health 

evaluations.

The planning committee also should identify the availability of community and 

government resources that focus on critical issues that disproportionately tend to affect 

people with mental illnesses (such as housing, employment, education, substance abuse 

treatment, and veterans’ services). An assessment of their accessibility in the community 

should be part of the planning process.

Systemwide Solutions

The 2002 landmark Consensus Project Report—written by Justice Center staff and representatives 

of 100 leading criminal justice and mental health policymakers, practitioners, and advocates 

from across the country—provides policy guidelines and practical recommendations for 

improving the criminal justice system’s response to people with mental illnesses. The policy 

statements and recommendations span the entire criminal justice continuum, from the law 

enforcement encounter, through court involvement and incarceration, to the individual’s 

reentry into the community. The success of recommended efforts is dependent on collaboration 

and partnership among the full range of criminal justice agencies and their community 

partners. It recognizes that law enforcement, courts, or corrections officials’ actions have 

ramifications for the rest of the criminal justice system. 

This interconnectedness highlights the value of creating a systemwide commitment to 

change, in which reforms at each point of contact between the individual with mental illness 

and a different criminal justice agency are woven together. There is a wide variety of program 

models that focus on a different point of intercept in the criminal justice system, including the 

following: 

• Law enforcement specialized responses, which use specially trained law enforcement 

officers to de-escalate incidents involving people with mental illnesses and divert them to 

services when appropriate.

• Mental health courts, which are specialized dockets that link defendants with mental 

illnesses to court-supervised, community-based treatment in lieu of traditional case 

processing when warranted. 

• Post-booking jail diversion programs, which screen and assess people with mental 

illnesses in the jail, and divert them to community-based services when suitable.

• Specialized probation caseloads, which integrate community corrections supervision 

strategies with community-based mental health treatment and services through a variety 

of methods.

For more information on the Consensus Project report and the many program models, see 

www.consensusproject.org.

spotlight
Step by Step: The Program Design Process 15

Step 6:

Determine training requirements

Once planners determine which types of responses are best suited to their local needs and 

resources (such as a specially trained unit, co-responder model for a subset of officers, or all 

officers who respond with special unit backup), the group can begin developing a training 

curriculum and schedules. Both law enforcement and mental health agencies or providers 

will have concerns about their ability to afford and prepare quality training, including how 

to address such issues as compensation for trainers, continued education accreditation, 

and covering shifts for officers in training or fitting it into already packed recruit training 

schedules. These concerns need to be factored into decisions about how many and how often 

first-responders are trained.

Question 1: How much training will be provided and to 

which law enforcement personnel? 

How much training is not only a question of hours spent in 

the classroom, but also of the number of officers trained and of 

how often training is held. Many agencies with specialized law 

enforcement-based response programs require that 20 percent 

of the department’s officers receive forty hours of training.24

However, there are other approaches that planners can consider, 

including increased training on mental health issues for recruits 

or ongoing education requirements for all officers. Dispatchers 

and call takers will also require training on the program model, 

to help them identify calls for service that may involve a person 

with mental illness and then to dispatch the correct personnel to 

the scene. They may also be able to ask questions that can help 

officers who arrive at the scene, and to collect information about 

24. The CIT Center at the University of Memphis has released the “Crisis Intervention Team Core Elements” 

(available at http://cit.memphis.edu/CoreElements.pdf), which outlines their suggestions for length of training 

(forty hours) and the number of officers trained within an agency’s patrol division (20 to 25 percent). The guide 

provides detailed information about the Memphis CIT Model.

25. To learn more, download Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement 

Training from www.consensusproject.org/issue_areas/law-enforcement.

Specialized Training

All law enforcement personnel who respond to incidents in which 

an individual’s mental illness appears to be a factor receive training 

to prepare for these encounters; those in specialized assignments 

receive more comprehensive training. Dispatchers, call takers, and other 

individuals in a support role receive training tailored to their needs.25

Essential 

Element

3

Some law enforcement 

agencies only send officer 

volunteers to attend the 

training, while others 

send all officers. There are 

always some officers at the 

training who don’t want 

to be there. After a day or 

two, though, even reluctant 

officers understand that 

this program is about officer 

safety.”

—Patrick Halpern

Executive Director, Mental Health 

Association of the New River 

Valley, Inc., Virginia
16 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

the disposition of calls involving people with mental 

illnesses to help administrators determine the number 

and effectiveness of specialized responses.

Question 2: What topics should training cover? 

Training curricula should be geared toward the 

particular law enforcement personnel (line-level, 

special teams, dispatchers) and include information 

specific to the jurisdiction (for example, state 

commitment laws and local resources). Although 

there is no single curriculum that will address the 

needs of all jurisdictions, several training topics form 

the foundation of a comprehensive training program. 

These include understanding mental illness, statutory 

authorities governing law enforcement responses, 

the law enforcement response to calls for service, 

community policing/problem solving, and use of 

force.26 The training is not intended to turn law 

enforcement officers into diagnosticians, but rather 

to train them to look for behaviors associated with 

mental illnesses and determine the best way to address 

those behaviors. Specific skills training may include 

a combination of verbal de-escalation techniques and 

suicide prevention methods. 

Question 3: Who will provide the training? 

Training for law enforcement officers on effective responses to people with mental illnesses 

must draw on a diverse range of expertise and perspectives to cover a broad range of topics, 

from recognizing signs of mental illness to understanding the state’s emergency evaluation 

laws. Many of these topics may be better taught by experts from disciplines other than law 

enforcement. For example, signs of mental illnesses may be taught by a psychiatrist or 

mental health clinician, whereas de-escalation techniques may be best taught by a seasoned 

law enforcement officer who can provide real-life examples. Consumers and family members 

can provide a face and a voice for people struggling with mental illnesses, and they are 

uniquely qualified to promote a compassionate response from officers who often see people 

with mental illnesses only when these individuals are in crisis. Training coordinators might 

not know who would be a good fit to teach all modules, so it is important that coordinators 

reach out to community partners to collaborate on identifying trainers or facilitators.27

26. This list is drawn from Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement 

Training, “Appendix B: Suggested Training Topics,” page 41.

27. For more information on how to identify trainers, see “Chapter 1: Identifying Trainers” on page 8 of Improving 

Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement Training.

Because of the limitations 

posed by our jurisdiction’s 

size, in addition to forty 

hours of training for officers 

on our special teams, we 

decided to provide twentyfour hours of online training 

to all of our officers on 

mental health de-escalation 

techniques.” 

—Commander Harlan Ward

Assistant Commanding Officer of 

Valley Bureau, Los Angeles (Calif.) 

Police Department

It is important to provide 

training to all officers on 

encounters with people 

with mental illnesses, and 

e-learning has an important 

place in the picture.” 

—Mark Gale

Member, Board of Directors, 

NAMI–California
Step by Step: The Program Design Process 17

Question 4: What training strategies will be employed?

Effective training strategies are critical to a specialized law 

enforcement-based program. These strategies may include 

short lectures that focus on behaviors and plain language 

rather than diagnoses and medical terms; site visits to some 

of the mental health facilities where they will do custodial 

transfers or refer individuals for treatment or support; 

role plays to engage officers in real-life interactions that 

can be acted out and corrected in a safe environment; and 

question-and-answer sessions to prompt officers to consider 

and discuss their own experiences, preconceptions, and 

concerns. Traditional classroom-style training is invaluable, 

but as a supplement, many agencies have started to develop 

e-learning platforms to engage personnel who work 

nontraditional hours and to increase access to specialized 

training topics.28

Step 7:

Prepare for program evaluation

It is not enough to simply identify what information will be collected (as outlined in Step 3) 

to ensure effective evaluations will be conducted. It is important for planners to prepare for 

a program evaluation as part of the design process. As previously mentioned, the program 

evaluation should contain both a process assessment as well as an assessment of outcomes. 

This evaluation will be needed to make revisions to the activities that may be experiencing 

difficulties and to enhance those that are effective, as well as to provide proof of the program’s 

success to foster sustainability. 

Question 1: What resources need to be set aside or identified for an evaluation? 

A thorough program evaluation will require the allocation of resources to analyze the data 

collected. Agencies with planning and research divisions may want to identify department 

staff and allocate a percent of their time during the program design phase to coordinate or 

conduct these evaluations. Agencies without research capacity may benefit from outside 

assistance in aggregating, deciphering, and interpreting the data to determine program 

effectiveness. Because of the challenges associated with data collection, as well as the 

difficulties in analyzing often incomplete data, many law enforcement agencies partner 

with a local college or university to assist with this process. Academic partners may require 

compensation for which law enforcement agencies may need to find sources of support, 

We trimmed the forty-hour 

training curriculum by 

determining what course 

content the officers really 

needed. We had a four and 

one-half-hour block on 

psychopharmacology, and 

while it is important to 

understand what these drugs 

are, the reason the police 

officer is there is because 

the person is NOT taking 

their medications. We now 

tell officers what these 

medications are, what they 

do, and give them a card to 

refer to.”

—Dr. Luann Pannell

Director of Police Training and 

Education, Los Angeles (Calif.) 

Police Department

28. For more information on training strategies, see “Chapter 2: Effective Training Techniques” on page 22 of 

Improving Responses to People with Mental Illnesses: Strategies for Effective Law Enforcement Training. 
18 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

including submitting joint grant proposals. If the department chooses to engage an external 

research partner, these outside teams will need to work closely with law enforcement and 

their collaborators during the evaluation process, and this staff time commitment should be 

considered at the planning stage.

Question 2: Are there individuals designated to oversee the evaluation? 

Law enforcement agencies should designate a staff person who will work with a 

subcommittee on evaluation issues. In addition to helping to ensure that all agencies that are 

contributing data are using sound and accurate collection and reporting practices, this group 

can determine how the evaluation results will be used, how they will be disseminated, and 

who should be brought to the table during the evaluation process to review interim reports 

and the interpretations of the data.

Conclusion

The seven steps to program design summarized in this section may seem straightforward. 

They are not. Law enforcement agencies and their community partners are struggling to 

navigate the many issues that are involved in making the proper decisions at each stage in the 

process. And as new information is made available, it is necessary to revisit previous steps. 

To fully grasp the challenges in following these design steps, policymakers and planners 

interested in exploring a specialized policing response to people with mental illnesses must 

operate within a framework defined by two complex forces—the nature of the problem and 

the jurisdiction’s distinct characteristics. 

Though the problem frequently relates to safety concerns and strains on police resources 

that do not result in good outcomes for law enforcement, the individual, or the community, 

jurisdictions may find that data and discussions lead them to other issues or sub-issues 

that need particular attention. Crafting the solutions to these problems—including changes 

to law enforcement training, policies, and procedures—cannot be shaped in a vacuum. 

Training officers on diversion and other strategies, for example, will be ineffective if mental 

health resources in the community are not available or lack the capacity to support increased 

referrals and placements. Accordingly, jurisdictions will be limited by the resources they have 

or believe they can create or expand. 

The following section explores how various problems and community characteristics have 

shaped responses in the agencies studied and how other jurisdictions might expect these 

factors to influence their own program design and enhancements.
From the Field: Program Design in Action 19

Section II

From the Field:

Program Design in Action

This section provides practical advice on how to consider 

common problems as experienced by the four sites 

studied. It also considers various law enforcement, mental 

health, and other community characteristics, and their 

relative impact on program design. Examples from the 

field are included to illustrate how these problems and 

characteristics are reflected in program implementation. 

Tailoring Specialized Policing 

Response Programs to Specific 

Problems29

The three most commonly encountered problems found 

in the four communities studied were unsafe encounters, 

frequent arrests of people with mental illnesses and 

the strains on law enforcement resources, and high 

utilization of emergency services. It is important to note 

that this separation of problems into distinct categories 

is somewhat artificial, as they often overlap and relate 

to one another. Other communities may find their data 

lead them to identify different problems beyond these 

three types. The chart that follows provides an overview 

of how the four sites tailored their responses to their 

community’s problems.

I feel that CIT changed our understanding of what the police 

officers are capable of doing with de-escalation and compassion.” 

—Jim Randall

President, NAMI–San Fernando Valley (Calif.)

It may well take a tragedy to 

mobilize the resources....” 

—Assistant Chief 

Jim McDonnell

1st Assistant Chief, Chief of Staff, Los 

Angeles (Calif.) Police Department

CIT is a godsend. The community 

of people with mental illnesses 

was getting badly treated and CIT 

has been an undisputed success. 

There are very few situations 

where the response is poor.”

—Tom

Consumer, Carriage House 

(Fort Wayne, Ind.)

If you want it to be collaborative, 

you need to be flexible and 

adapt this program to your local 

community.” 

—Sgt. Michael Yohe

CIT Coordinator, Akron (Ohio) 

Police Department

29. Cordner’s guide, “People with Mental Illness,” outlines a variety of response strategies that decision-makers 

can consider when choosing how to best respond to the problem they are facing in their local community. These 

response strategies are also summarized in a table that presents the response type, how it works, when it works, 

and additional considerations to take into account. 
20 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

The Impact of Problem Type on SPR Programs30

Problem Type Jurisdictions SPR Program Activities

Unsafe Encounters Los Angeles, Calif.

Akron, Ohio

Fort Wayne, Ind.

New River Valley, Va.

Officers trained on mental health issues respond 

to the scene when dispatched. (In the LAPD, 

a call can also be triaged to dispatch a special 

co-response unit. See box below.)

Related issues are addressed during training for 

officers on mental health topics.

Training is provided for dispatchers.

Frequent Arrests 

and Strains on 

Police Resources

Los Angeles, Calif. Co-responder teams are dispatched to the scene 

when requested by a first-responder.

Crisis mental health clinicians also respond to the 

scene.

Additional dispatch capability is used to “triage” 

incidents requiring the co-response team.

Akron, Ohio

Fort Wayne, Ind.

New River Valley, Va.

Related issues are addressed within the forty 

hours of training for officers.

Emergency psychiatric facilities streamline intake 

procedures for law enforcement.

High Utilization 

of Emergency 

Resources

Los Angeles, Calif.

Akron, Ohio

Follow-up teams of law enforcement personnel 

and mental health clinicians work on case 

management for referred cases, including 

cases brought to their attention by involved 

stakeholders.

Relatives of consumers are now less reluctant to involve the police because 

family members realize that a compassionate officer will respond to the 

call. Consequently, families do not wait until the situation has escalated, 

and officers now respond to less threatening calls. This allows them 

to intervene at an earlier point. No CIT officer has been injured when 

responding to a person with mental illness.” 

—Lieutenant Mike Woody (ret.)

Law Enforcement Liaison, Ohio Criminal Justice Coordinating Center of Excellence

30. Many of the “SPR Program Activities” listed here address more than one problem. In practice, these responses 

often straddle the goals of improving safety, reducing frequent calls for service, and decreasing the use of 

emergency resources. 
From the Field: Program Design in Action 21

Problem: Unsafe outcomes of encounters between 

law enforcement and people with mental illnesses

When communities experience a tragedy related to a 

law enforcement encounter involving a person with 

mental illness, there is often a flurry of activity to 

determine what factors contributed to that outcome and 

to ensure it will not happen again. Several factors seem 

to affect safety at the scene. Many community members 

interviewed for this project noted that when consumers 

have had previous negative encounters with law 

enforcement, they become fearful and distrusting during 

subsequent interactions. A person’s fear can then be 

exacerbated by the officer’s uniform and an authoritarian 

approach. Even individuals in crisis with no previous 

contact with officers may have extreme reactions to being 

crowded or subjected to officers’ commands. 

Community members interviewed also recognized 

that traditionally trained law enforcement officers often 

lack information about mental illnesses, particularly 

information about strategies to calm crisis behavior 

and avoid use of force. Without adequate training, 

officers may also be fearful of individuals with mental 

illness and may misperceive them as more dangerous, 

affecting officer posturing and reactions. It is important 

to recognize that much of an officers’ academy training 

is oriented toward taking control of a situation and 

resolving it as quickly as possible—which may run 

counter to specialized response strategies. These factors, 

together with dynamics such as the level of access 

to mental health supports, guidelines on less-lethal 

weaponry and tactics, and whether the individual is 

taking medications or is abusing drugs or alcohol, can 

all contribute to concerns about the safety of all those 

involved in these encounters.

Tailored Responses

Based on the sites visited and related project research, 

programs designed to respond to safety concerns during 

these encounters were found to be aimed primarily at 

officer education and quick, on-scene de-escalation of 

crisis behavior. Other responses include the training 

on and use of less-lethal weapons, helping call takers 

and dispatchers get the best possible information to the 

CIT provides the opportunity to 

really sit and listen more than 

talk. Usually we just tell people 

what we are going to do. I plan 

to try to volunteer for as long as I 

can—I see different things all the 

time.” 

—Officer Mark Bieker

CIT Officer, Fort Wayne (Ind.) 

Police Department

One of the largest complaints by 

NAMI and other advocates was 

the lack of understanding by the 

officers of how to communicate 

with people with mental 

illnesses.” 

—Commander Harlan Ward

Assistant Commanding Officer of 

Valley Bureau, Los Angeles (Calif.) 

Police Department

Injury on the job could lead to job 

loss—therefore, any opportunity 

to learn additional officer safety 

techniques is a plus.”

—Officer Lori Natko

CIT Officer, Akron (Ohio) 

Police Department

There are times when the police 

must run from call to call. But 

there will come a time when 

an officer’s compassion will be 

necessary to resolve a situation, 

and the officer will need to step up 

and come through.”

—Bernie

Mental Health Consumer (Akron, Ohio)
22 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Akron Tailors Response to Safety Concerns and Repeat 

Calls for Law Enforcement and Mental Health Services*

Quick Facts

Government type: Municipal

Jurisdiction type: Urban

Population in 2007: 207,934 (estimate)

Area of Akron in square miles: 62.4

Number of sworn personnel in 2006: 451

Number of civilian personnel in 2006: 43

Program name: Crisis Intervention Team (CIT)

Program start date: 2000

Overview

The Akron (Ohio) Crisis Intervention Team (CIT) was one of the first agencies to replicate the 

Memphis CIT Model. Although this community maintains fidelity to the model, they have made 

several adjustments to the core elements. For example, CIT Officers in Akron have access to four 

emergency resources, rather than the single point of entry available in Memphis. This adaptation 

was made to ease the burden on any single mental health facility. Akron has also modified the 

CIT training to include a segment about being a CIT officer, including safety issues, duties, and 

officers’ experiences. 

Tailored Responses

Once CIT was implemented, Akron stakeholders determined the need for a supplemental 

program to address the needs of their “at-risk” population—those individuals who are repeat 

clients of both the criminal justice and mental health systems and who often fall through the 

systems’ cracks. The “CIT Outreach Program” consists of a group of officers who team up with an 

outreach worker from Community Support Services (CSS). Officers in uniform ride together with 

a CSS worker in a marked cruiser to contact referrals and attempt to engage people in services. 

Akron reported that pairing a law enforcement officer with a case worker to conduct followup can also facilitate information sharing, locating individuals, and increasing the safety of 

encounters.

Outreach teams can refer individuals to mental health and other services, such as elder care 

and drug addiction services. When the team encounters someone who does not qualify for an 

involuntary commitment order, they are often able to persuade the person to voluntarily go to 

CSS, where they are welcomed in the back door with dignity and discretion. 

Unique Program Features

The CIT program coordinator in Akron maintains his patrol duties, which lends credibility to 

the program and assists in soliciting officer involvement. When the outreach team transports 

an individual in a marked cruiser, he or she rides without handcuffs in the back seat with 

the mental health case manager. The person may meet criteria for emergency mental health 

evaluation, but the officer allows the person to ride without handcuffs when the situation is 

under control. If the person is at risk of harming him- or herself or others, or attempts to leave, 

the police will then use handcuffs and transport as needed.

* Dates and figures in this sidebar are consistent with the most recent information available at the time of 

this writing.
From the Field: Program Design in Action 23

Fort Wayne Tailors Response to Safety Concerns and 

Problems in Schools*

Quick Facts

Government type: Municipal

Jurisdiction type: Urban

Population in 2007: 251,247 (estimate)

Area of Fort Wayne in square miles: 79.12 

Number of sworn personnel 2006: 435

Number of civilian personnel 2006: 100

Program name: Crisis Intervention Team (CIT)

Program start date: 2001

Overview

Fort Wayne (Ind.) operates a traditional CIT program. Law enforcement plays a primary role in 

the program, but it is also shaped by mental health consumers, available resources, and a strong 

NAMI presence. Fort Wayne made several adjustments to the traditional CIT model. CIT officers 

in Fort Wayne have access to two hospitals and a transitional care center, where Memphis has 

only a single point of entry to mental health emergency services. This change broadens the range 

of services available to CIT officers, and the hospital and transitional care center staffs assist in 

transporting consumers to the hospital where they may have received services in the past. Fort 

Wayne also added training topics on problems of concern that were not required in the Memphis 

curriculum, such as a unit on autism. 

Tailored Responses

After implementation of the CIT program, Fort Wayne identified several problem behaviors 

among middle and high school students. In some cases, self-mutilating behavior was detected, 

and in other cases, schools were struggling to manage the behavior of “bad kids.” Their only 

options at that time were to expel these students or have police arrest them for such acts as 

vandalism. 

To address these school problems, CIT program planners began providing CIT training to all 

of the School Resource Officers (SROs). In addition, a CIT-trained officer has helped identify high 

school students who might benefit from mental health services. This officer’s training enabled 

him to recognize that some students were not simply acting out, but may have serious mental 

health problems. On more than one occasion, this officer used his training to gain a student’s 

trust, so the student could talk openly about what was happening in his or her life and get help. 

Unique Program Features

Fort Wayne is fortunate to have the extensive involvement of a judge who reviews all civil 

commitment hearings and participates in officer training. Their program also uses a “stat sheet” 

to collect information on the number of calls the police get, how many are diverted at the scene, 

how many are brought to the hospital for twenty-four-hour observation, and how many are kept 

for seventy-two-hour holds. The form also collects data on the presence of weapons and whether 

the case involved a suicide attempt. This stat sheet then follows the consumer through the 

mental health system. If he or she is brought to the emergency room and a need for detention is 

identified, the stat sheet becomes the “face sheet” for the seventy-two-hour hold and is faxed to 

the judge for review. All face sheets are retained in the police department’s records, are analyzed 

on a monthly basis to track program responses, and are reviewed by the Judge and CIT Sergeant 

for accuracy. Summary data are shared appropriately to keep all stakeholders routinely informed 

about program progress.

* Dates and figures in this sidebar are consistent with the most recent information available at the time of 

this writing.
24 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

officers suited to address the situation, developing means 

for capturing information that will improve safety for 

repeat calls for service, and involving a secondary mental 

health response.

Programs that respond to safety concerns emphasize 

specialized training on policies and practices designed 

to help law enforcement officers take adequate time 

and steps to identify the signs and symptoms of mental 

illnesses. These programs reflect the understanding that 

these behaviors may be the result of an illness, draw 

on effective communication and behavioral strategies, 

and familiarize officers with less-lethal force options. 

Training includes the opportunity for role-play scenarios 

that enable officers to practice and hone their skills in 

addressing “real-world” crises before applying them 

in the field. These skills include those involved in 

maintaining the safety of all involved and determining 

whether the person meets the criteria for emergency 

mental health evaluation. Specially trained law 

enforcement officers apply their new skills in the field 

to determine if the situation involves a person who may 

have a mental illness. If it does, officers are trained to deescalate the person’s behavior and to connect him or her 

to treatment when appropriate. When safety concerns 

involve educational institutions, additional personnel 

may receive specialized training. In Fort Wayne, for 

example, the department requires that all school resource 

officers (SROs) attend CIT training. 

Specialized training for call takers and dispatchers 

is critical to officer and consumer safety. This training 

provides tools for call takers to identify calls that may 

involve a person with a mental illness, gather important 

information about the situation from the caller (for 

example, when possible, the person’s previous reactions 

to law enforcement, the person’s medication status, 

any history of violence) and provide that information to 

responding officers. Dispatchers follow specific protocols 

to help ensure that specially trained officers respond 

quickly to incidents they believe may involve a person 

with a mental illness.

Call takers clear calls and make notations in the CAD 

system about the involvement of weapons or violence 

to enhance safety should this location draw future 

calls for service. For example, in Akron, dispatchers 

The police response 

has become seamless 

and is totally accepted. 

Consumers even call police 

themselves now, which 

would not have happened 

prior to CIT.” 

— Jane Novak

Member, NAMI-Indiana 

Our dispatchers are trained 

in verbal de-escalation 

and can sometimes avoid 

dispatching the police by 

talking down the individual 

on the phone.” 

—Lorie Witchey

Dispatcher, Akron (Ohio) 

Police Department

I was a practicing public 

defender for ten years and 

saw how many clients had 

real issues with mental 

health and co-occurring 

substance use disorders. I 

knew these people would 

benefit from treatment and 

should not be in jail. Once 

they were in jail, they got 

stuck there.” 

—Victoria Cochran

Chair, State Mental Health, 

Mental Retardation and 

Substance Abuse Services Board 

Don’t let anyone tell you we 

did not have a problem with 

arresting people who were 

mentally ill. Our people 

didn’t realize they had a 

mental illness and we were 

putting them in jail when 

they were sick.” 

—Officer Danny Ratcliffe

CIT Officer, Pearisburg (Va.) 

Police Department (NRV)
From the Field: Program Design in Action 25

review incident reports and flag locations relating to a 

person with mental illness, focusing on the presence 

of a weapon or specific strategies that may have proven 

successful in de-escalating an encounter with the subject 

of the call for service. This information can be used to 

improve the dispatching and response of officers for any 

future calls to that location.

When tailoring a response program to safety 

concerns, the interviewed sites only included onscene mental health experts as a secondary response. 

For example, in the agencies studied, a mental health 

professional might come to the scene, but only after the 

People were going to jail when 

they should not have. If you 

are mentally ill, jail is not the 

solution.” 

—Amy Tyler

Director of Behavioral Health, 

St. Joseph Hospital (Fort Wayne, Ind.) 

New River Valley Tailors Response to Safety Concerns in 

Rural and Small Communities*

Quick Facts†

Government type: County, Municipal

Jurisdiction type: Rural, multi-jurisdictional

Population in 2007: 172,255 (estimate) 

Area of New River Valley in square miles:

1,469 (estimate) 

Program name: New River Valley Crisis 

Intervention Team 

Program start date: 2002

Overview

In response to growing concerns about the number of people with mental illnesses in the 

criminal justice system, program planners in New River Valley, Va., developed a multijurisdictional CIT that involves fourteen different law enforcement agencies within four counties 

and one city in a largely rural area. These agencies have found it difficult to implement state 

mandates that people with mental illnesses who qualify for emergency assessment must remain 

in the custody of law enforcement officers until an emergency service clinician can complete 

the assessment, and if necessary arrange for mental health services. Prior to the site visit, law 

enforcement custody could last up to four hours and individuals could not be placed in jail. 

(Legislation in 2008 increased the mandatory custody up to six hours to provide sufficient time 

for the provision of medical clearance.) Mental health resources are limited and the rural nature 

of the community requires emergency service clinicians and law enforcement officers to travel 

long distances to conduct assessments and then transport individuals to available inpatient 

facilities. The Mental Health Association (MHA) in Blacksburg, Va., funds a CIT coordinator, 

whose responsibilities include arranging for CIT training.

* Dates and figures in this sidebar are consistent with the most recent information available at the time of 

this writing.

† Population and area figures of the New River Valley are aggregate numbers for the jurisdictions that make 

up the “valley:” Montgomery County, Pulaski County, Floyd County, Giles County, and the independent City of 

Radford. Given the multi-jurisdictional structure of the region, data were not available on the number of law 

enforcement personnel.

continued on next page
26 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Tailored Responses

The New River Valley CIT brought together fourteen jurisdictions that all fell within one of 

Virginia’s mental health catchment areas. The goal of bringing the smaller, rural communities 

together was to capitalize on shared resources. For example, agencies created agreements to 

allow officers to cross jurisdictions and serve each other’s residents, and developed a plan to 

provide CIT training to approximately 25 percent of the total number of patrol officers from the 

combined forces to have sufficient coverage of shifts and locations. 

To address the burdens placed on law enforcement and emergency service clinicians who 

must travel long distances and spend hours maintaining custody of people who are in crisis, 

program planners also intend to streamline procedures so that law enforcement officers can 

take a person in crisis to a mental health facility and transfer custody to another designated 

law enforcement officer stationed at the hospital. The hospital would then arrange for 

appropriate assessment and placement if needed.

Unique Program Features

Stakeholders in the New River Valley note the profound impact the Virginia Tech shooting 

in April 2007 had on mental health resources, particularly on inpatient hospitalizations. 

According to the director of the New River Valley Community Services, there was a 99 percent 

increase in hospitalization rates for children and youth after the shooting incident. Another 

significant outcome of this tragic event was the enactment of new legislation that increased—

from four to six hours—the amount of time a person in mental health crisis could be detained. 

To offset the demand this placed on law enforcement, the new legislation also allows “trained 

security officers” to accept people who have an emergency custody order and to do paperwork 

for emergency custody orders.

Due to differences in staffing and leadership styles, the participating law enforcement 

agencies vary in their perspectives about how many—and which—officers in their agencies 

should get CIT training. Consequently, the MHA trains some officers who do not volunteer 

for the assignment and trains all officers from some of the agencies. The MHA director notes 

that although some participants appear reluctant at the outset of training, two strategies 

tend to transform them. First, even people who don’t want to participate in the CIT program 

have a very different attitude about mental health consumers once they have been to the site 

visits, where they meet with people who have mental illnesses who are doing well. Second, 

information that stresses the impact of the CIT approach on officer safety can change the 

minds of trainees who are otherwise disinclined to support a SPR.

New River Valley continued

The biggest problem with small departments is if we get taken 

on a call where the person needs placement in a hospital, the 

officer will be off-road for a whole shift. Oftentimes, we may 

only have a total of two or three officers on a shift.” 

—Officer Danny Ratcliffe

CIT Officer, Pearisburg (Va.) Police Department (NRV)
From the Field: Program Design in Action 27

person’s behavior is stable and the officer is in control of 

the situation. Typically in these response models, officers 

will transport the person to a mental health facility where 

mental health experts can conduct further assessment 

if needed. Individuals interviewed in the studied sites 

underscored that it is essential that these facilities allow 

law enforcement officers efficient access to a wide range 

of services. 

Problem: Frequent arrests of people with mental 

illnesses and strains on police resources

Officers typically have three options when they encounter 

someone with a mental illness whose behavior is 

erratic—they can arrest the person if there is evidence 

a crime was committed, transport the person to a 

mental health facility in accordance with applicable 

legal mandates, or stabilize the situation and leave the 

person at the scene. Community members in each of 

the four sites identified several problems related to the 

limited options available for officers when encountering 

people with mental illnesses. Some stakeholders believed 

officers arrested people with mental illness who had 

committed minor offenses much too frequently. In most 

of these cases, individuals reported that the person’s 

behavior may have been too disruptive for the officer to 

leave him or her alone at the scene, and the officer did 

not have adequate information about—or efficient access 

to—available mental health resources. 

In other communities, stakeholders noted problems 

that occur when an officer must either remain with the 

person in crisis until a mental health professional arrives 

to conduct an assessment or transport the person to 

an emergency room, where they may spend additional 

hours waiting for the assessment to take place. 

Tailored Responses

Programs developed in response to inefficient access 

to mental health resources use strategies to make these 

facilities more “officer-friendly.” In Fort Wayne, for 

example, the receiving facilities’ administrators adapted 

their procedures to prioritize intake for consumers 

who officers bring to the facility, allowing the officers 

to complete paperwork quickly and return to other 

Since CIT was implemented, 

fewer people are going to jail. 

The contacts are better and 

there are fewer arrests.” 

—Andy Wilson

Executive Director, Carriage House 

(Fort Wayne, Ind.)

Our CIT program has diverted a 

fair number of people from jail to 

the mental health system, which 

is improving the balance between 

the legal system and the mental 

health systems.” 

—Deb Richey

Nursing Director of Emergency 

Services, Parkview Hospital 

(Fort Wayne, Ind.)

Before CIT, officers were 

frustrated they had to wait a long 

time before transferring custody. 

With CIT, they could drop their 

paperwork off and scoot.” 

—Amy Tyler

Director of Behavioral Health, St. 

Joseph Hospital (Fort Wayne, Ind.)

Law enforcement officers felt 

isolated from other service 

providers before CIT, and their 

knowledge of available resources 

was limited.” 

—Sgt. Michael Yohe

CIT Coordinator, Akron (Ohio) 

Police Department
28 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

duties. In addition to minimizing the strain on law 

enforcement time and resources, these efficiencies 

can decrease the number of people who may 

otherwise be taken to jail for minor offenses. When 

coupled with officer training on local mental health 

resources and de-escalating behaviors that might 

otherwise result in more serious charges against the 

individual, these changes can improve outcomes 

for the person with mental illness and the law 

enforcement first-responders.

Law enforcement responses that address poor 

knowledge about and limited access to mental health 

resources can also pair a law enforcement officer and 

mental health service provider to respond together 

to calls involving someone with a mental illness. In 

most cases, co-responder teams are dispatched as a 

“secondary” response. For example, in Los Angeles, 

patrol units are dispatched to calls based on priority, as 

is the usual practice.31 Once the patrol officer gets to 

the scene, he or she will make a determination about 

whether mental illness may be a factor and if the 

co-response team is needed. When the co-responder 

team arrives, the initial responding patrol officer 

manages safety concerns. The co-response team—

both the law enforcement officer and the mental 

health clinician—focuses on the person with mental 

illness, making decisions about an assessment, 

referral for service, and placement.32

In Los Angeles, an additional layer of dispatch 

is in place to facilitate this model. Law enforcement 

first-responders can ask patrol dispatchers for a 

Systemwide Mental Assessment Response Team 

(SMART); the dispatchers then route their call to the 

“Triage Center” of the Mental Evaluation Unit (MEU), 

where an officer assesses when to send out teams. 

This triage officer can access the MEU database to 

gather information on the criminal justice history 

for the subject of the call for service. The forensic 

nurse, who is co-located in this unit, can access the 

Department of Mental Health (DMH) records. Both 

Patrol commanders and those 

who respond to critical incidents 

are learning that mental health 

components are regularly 

an issue, and therefore, they 

recognize the value of MEU on 

these scenes.” 

—Lt. Michael Albanese (ret.)

SWAT Commander, Los Angeles 

(Calif.) Police Department

Through the partnership, police 

officers often learn to mirror 

the techniques that the mental 

health practitioners use in 

handling situations with people 

with mental illnesses.” 

—Dr. Tony Beliz

Deputy Director, Emergency 

Outreach Bureau, Department of 

Mental Health, Los Angeles County 

(Calif.) 

Officers in [the CIT] program 

come to recognize the 

weaknesses in the mental health 

system and how to navigate 

them to benefit the consumer.” 

—Ron Rett

Member, NAMI-Ohio

It is the chief’s responsibility 

to balance resources, which 

involves practice, vision, and 

creativity. There is a resource 

benefit to the co-responder 

model: pairing a civilian with a 

sworn officer frees up other twoofficer cars.” 

—Chief William Bratton

Los Angeles (Calif.) Police Department

31. When a call for service involves a person or place that has generated a high volume of previous police 

responses, the dispatch system flags any mental health issues and the dispatcher shares that information with 

the responding officers. 

32. The Los Angeles County Department of Mental Health not only coordinates response teams with the Los 

Angeles Police Department, but also with agencies in Long Beach and Pasadena. 
From the Field: Program Design in Action 29

sources of information can guide the triage and ensure 

the responding team will have a more comprehensive 

history on the individual. When SMART is dispatched, 

the first-responder officers stay at the scene until the 

person in crisis has been stabilized. This provides 

support and backup to the SMART officer and the 

mental health clinician. 

Even in agencies where there is no co-location of 

law enforcement and mental health personnel, coresponder teams can improve linkages to mental health 

or substance abuse treatment. Because the mental 

health professional has access to the person’s mental 

health history, the team may be able to reconnect the 

person to a clinician who has previously treated him or 

her. In addition, mental health professionals working 

with law enforcement are knowledgeable about a wider 

range of services and supports, so they can find the 

most suitable mental health approach to the individual’s 

needs. According to those interviewed for the project, 

co-responder teams can also assist in transportation to 

a mental health facility for a greater range of situations 

than law enforcement could alone. For example, the 

team may have more time to transport people who 

meet the criteria for involuntary evaluation to the 

mental health facility, which frees the first responding 

officer to return to patrol. In addition, because of the 

involvement of a mental health professional at the scene, 

co-responder teams may be able to transport people 

voluntarily to services and supports that would otherwise 

rely on a family member or public transportation. 

Problem: High utilization of emergency resources 

Many communities experience a large number of law 

enforcement calls to the same locations, involving the 

same people with mental illnesses without positive 

effect. Many of these same individuals have been found 

to also repeatedly need emergency medical services. This 

small group of consumers, often referred to as “high 

utilizers” of emergency services, typically represents 

people who are difficult to keep connected with 

nonemergency services, including continuous treatment 

that is effective in relieving their symptoms. In some 

cases, these individuals have co-occurring substance 

use disorders, are homeless, or both. They may cycle in 

Law enforcement leadership must 

know how to apply the necessary 

resources to solving crimes [and 

disorder]. The best way to apply 

limited resources is to focus on 

the 10 percent of the population 

that uses the greatest amount of 

resources.” 

—Chief William Bratton

Los Angeles (Calif.) Police Department

One challenging population is 

[the group of individuals] who are 

drug- or alcohol-dependent. They 

are only at our hospital for a short 

period of time and a large group 

does not follow through with 

treatment recommendations. 

This can result in a revolving 

door. The officer goes to the scene, 

brings the person in, we end up 

admitting them, and discharge 

them two to three days later. 

When they do not follow through 

with treatment, they will be 

back.” 

—Patsy Hendricks

Director of Clinical Services, Parkview 

Behavioral Health (Fort Wayne, Ind.)

I believe it is in part because of our 

CAMP program that L.A. hasn’t 

had [a mass shooting incident]. 

Once we identify someone who 

has mental illness [that puts 

them at risk of criminal justice 

involvement] and put them in 

the CAMP program, we monitor 

them to make sure they get 

medications, have housing, go 

to work, and can take care of 

themselves.” 

—Captain Ann Young

Commanding Officer, Detective 

Support and Vice Division, Los Angeles 

(Calif.) Police Department
30 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Los Angeles Tailors Response to Safety Concerns and 

High Utilization of Emergency Services*

Quick Facts

Government type: Municipal

Jurisdiction type: Urban

Population in 2007: 3,834,340 (estimate)

Area of City of Los Angeles in square miles: 

498.3 

Number of sworn personnel: 9,883

Number of civilian personnel: 3,263

Program names: Systemwide Mental 

Assessment Response Teams (SMART) and 

Case Assessment Management Program 

(CAMP)

Program start dates: 1993 and 2005, 

respectively

Overview

Los Angeles has implemented several complementary program responses to address the complex 

needs of the jurisdiction. Los Angeles was one of the first communities to develop the police/

mental health co-responder teams (SMART) in 1993. This program was designed to better link 

people with mental illnesses with appropriate mental health services. When the department 

came under a U.S. Department of Justice consent decree in 2001, one provision directed the 

agency to improve safety for all involved in officer encounters with people with mental illnesses. 

At that time, the department also began implementing a CIT program in pilot locations. 

However, due to its sheer size, both in area and in population, training the recommended 20 

percent of its officers in CIT protocols could not effectively cover rapid responses. As a result, 

department leaders chose to prioritize CIT training for officers most likely to come in contact 

with people in a mental health crisis, although the training is not limited to these officers. 

Tailored Responses

After implementation of CIT training and the SMART teams, a serious problem remained. A 

group of people with mental illnesses who called the police repeatedly, or were the subject 

of many calls for service, were costing the city millions of dollars in emergency resources. 

Further, a large percentage of SWAT call-outs involved someone with a mental illness. The police 

department developed the Case Assessment and Management Program (CAMP) to identify and 

track the subjects of these repeat calls, and construct customized responses to their problems. 

The program co-locates a police detective with psychologists and social workers from the 

county mental health agency in the police department facility. This team develops long-term 

solutions to an individual’s needs on a case-by-case basis. In particularly complex situations, 

team members have conducted home visits on a daily basis, linked a person to service provision 

in his or her home, provided transportation assistance, or made appointments for services or 

treatment. The team members focus on developing trusting relationships with people in need 

and few resist the help. 

The CAMP program receives referrals from both SMART officers and mental health 

professionals. When CAMP receives a referral, the psychologist reviews the information, 

accesses the Department of Mental Health (DMH) records, and reviews the person’s history with 

the police. The psychologist makes the determination about whether the person qualifies for 

CAMP. For example, someone may qualify if incidents with the police have been high profile, if 

the person is accessing more than three emergency resources, or the person has a large number 

* Dates and figures in this sidebar are consistent with the most recent information available at the time of 

this writing.

continued on next page
From the Field: Program Design in Action 31

and out of treatment, and many do not follow through 

with treatment plans independently, including taking 

prescribed medications. 

Tailored Responses

In Los Angeles, repeat calls for service led to the 

creation of the Case Assessment and Management 

Program (CAMP), which is a response strategy that 

focuses on proactive efforts to resolve the issues that 

generate repeat calls to police and others, including 

mental health case management and rigorous followup. CAMP teams include detectives from the police 

department and mental health clinicians, who work 

together to create customized plans for identified 

individuals. The CAMP team, which is located in the 

MEU area of the police department, receives referrals 

from many sources, including SMART officers, the 

Los Angeles Fire Department, school police, other city 

police officers, other LAPD detectives/investigators, 

and from mental health department personnel.

of calls to the police over a short period. CAMP cases are worked by the psychologist, a detective, 

and a police officer. At this initial stage (level 1) the team develops and implements a plan for 

mental health treatment and strategies for managing services. When the person stabilizes (level 

2), the case shifts to periodic monitoring. For example, the detective may contact some clients 

every week to check in, or stop by once a month. If the person remains stable and the family does 

not need help, the case becomes inactive (level 3) and is filed.

Unique Program Features

The department formed the “Mental Evaluation Unit (MEU)” to oversee all of these programs 

and manage points of intersection. The MEU contains a triage unit that fields calls from patrol 

officers who have questions about what to do in certain situations involving people with 

mental illnesses. In these circumstances, the triage officer consults the MEU database (separate 

from the CAD system and protected from access outside the unit) to learn this person’s history 

with the police. A triage mental health nurse sits alongside this officer and can check the DMH 

databases to determine the person’s case manager, psychiatrist, or treatment centers. The triage 

staff determines together whether to send out a SMART team or have the officer take the person 

directly to a mental health facility. If the triage unit determines that this person has repeatedly 

contacted police (or been the subject of frequent calls for intervention), they will refer the person 

to the CAMP coordinator for follow-up. 

Los Angeles continued

The outreach team allows officers 

to see people when they are not in 

crisis—to see them as people. It 

also allows the consumers to have 

a positive and compassionate 

experience with the officers.” 

—Helen Reedy

Member, NAMI-Ohio

There is pressure to handle a 

high volume of calls for service, 

and short-term fixes are often 

a reality. The outreach team 

follow-up with a consumer allows 

the police to start implementing 

longer-term solutions.” 

—Sgt. Michael Yohe

CIT Coordinator, Akron (Ohio) 

Police Department
32 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

In Akron, a similar experience with “repeat callers” prompted the creation of CIT 

Outreach Teams, which consist of a law enforcement officer who partners with a mental 

health case manager to conduct follow-up with consumers in the community. This is not a 

routine assignment for the officers; they must choose it as an off-duty assignment. Outreach 

Team assignments come from referrals from mental health service providers, probation 

officers, and from law enforcement officers who identify individuals who would benefit from 

follow-up visits. The CIT coordinator at Community Support Services (CSS) prioritizes the 

referrals based on mental health and criminal justice history. A list of repeat call locations is 

also provided for follow-up and prevention efforts. Follow-up visits can result in a transport 

to CSS, where psychiatrists or case workers can provide additional treatment and support, or 

directly admit the individual to a hospital.

PROGRAM EXAMPLE: Responding to homelessness, Fort Lauderdale (Fla.)

Given that a large number of homeless individuals suffer from mental health issues, Fort 

Lauderdale (Fla.) created a Homeless Outreach Unit to bring shelter, assistance, and understanding to the homeless population. The outreach team includes an officer and a mental 

health worker who try to address the myriad needs of the “homeless mentally ill population.” 

The officer’s assignment is voluntary because participating in the program requires a sincere 

compassion and commitment to assist people in crisis. The team’s officer confirmed that 

“these people have complex problems, they need medications they cannot afford, and the 

team needs to empathize with them.”

The team gets referrals from law enforcement officers, but also establishes a pick-up location for three hours each day to assist people who are homeless or have just been released 

from long-term programs. The officer interviews them and tries to link them with social services and shelters.33

The outreach teams served as a 

natural complement to the CIT 

program. Referrals did not only come 

from mental health service providers, 

but also from officers who identify 

individuals that would benefit from 

follow-up visits.”

—Ragan Leff

CIT Coordinator, Community Support 

Services (Akron, Ohio)

I have responded to fewer CIT calls 

over time because of the positive 

effect of the outreach teams in 

decreasing repeat callers.” 

—Officer Lori Natko

CIT Officer, Akron (Ohio) 

Police Department

33. The information presented in this program example was developed based on a phone interview conducted 

during the information-gathering phase of this project. For more information about the Fort Lauderdale 

Homeless Outreach Unit, see the profile available on the Local Programs Database at www.cjmh-infonet.org/

main/show/2071.

CAMP team members develop responses on a case-by-case basis, and they range considerably. 

For complex cases, we conduct home visits—as often as daily—to link the person to services, 

in their home if needed, and obtain consent for our clinicians to speak to the person’s 

psychologist to check on whether the person is making and keeping appointments.” 

—Detective Teresa Irvin

CAMP Coordinator, Los Angeles (Calif.) Police Department
From the Field: Program Design in Action 33

The Impact of Jurisdictional Characteristics

on SPR Programs

Characteristic

Specific Jurisdictional 

Characteristics Jurisdictions SPR Activities

Law 

Enforcement 

Agency

Leadership style is consistent 

with “specialist” approach

Akron, Ohio

Fort Wayne, Ind.

Los Angeles, Calif.

New River Valley, Va.

A subset of self-selected law enforcement 

officers are assigned to teams.

Leadership style is consistent 

with “generalist” approach

Los Angeles, Calif.

New River Valley, Va.

All officers receive training in basic 

de-escalation and recognizing mental illness.

Conducted Energy Devices 

(CEDs) are used broadly as part 

of departmentwide use-of-force 

protocols

Akron, Ohio Only CIT officers are provided with CEDs.34

Conducted Energy Devices 

(CEDs) are used infrequently as 

part of departmentwide use-offorce protocols

Fort Wayne, Ind. CIT officers are not provided with CEDs.

Mental Health 

System

Medical clearance is required 

before admission to a mental 

health facility

Fort Wayne, Ind. Hospital emergency room protocols provide 

quick medical and mental health assessments 

in a secure area.

Mental health resources are 

extremely limited/inaccessible

New River Valley, Va. Officers are trained to identify better 

those in need of emergency mental health 

assessments.

State Laws Involuntary emergency mental 

health assessment requires 

extended police custody

New River Valley, Va. Officers are trained on de-escalation to enable 

them to manage safety concerns during 

custodial period. 

Law enforcement officers can be stationed at 

an emergency psychiatric facility to receive 

custody from patrol, freeing them to return to 

routine duties.

Demography 

and

Geography

Large, urban jurisdictions Los Angeles, Calif. SMART units are assigned specific areas of 

responsibility and work in conjunction with 

the more than 800 officers who receive some 

mental health training to provide citywide 

coverage. All officers receive some online 

training.

Small, rural jurisdictions New River Valley, Va. The forces of multiple jurisdictions are 

combined to increase the number of trained 

officers who can respond to a large area.

Medium, urban jurisdictions Akron, Ohio Department trained 19 percent of total sworn 

personnel in the department to respond.

Fort Wayne, Ind. Department trained nearly 20 percent of 

total sworn personnel in the department to 

respond.

34. Although accurate at the time of the interviews in 2007 and 2008, both the Akron Police Department and Fort Wayne Police 

Department have since revised their respective policies on CEDs. See page 35 for more information about the evolution of these 

changes.
34 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Tailoring Specialized Policing Response Programs to 

Jurisdictional Characteristics

As distinct from the previous discussion about problems and their impact on the specialized 

response program, jurisdictional characteristics are largely static features in a community 

or agency, which policymakers and planners must consider in program design and 

implementation. (These are reviewed briefly in Section I.) The following discussion examines 

how the jurisdictional characteristics, such as those outlined in the summary chart on 

the previous page, shaped program responses. These factors include law enforcement 

agency characteristics (such as leadership and use-of-force protocols), mental health system 

characteristics (such as resources and medical clearance requirements), state law (such as 

those regarding emergency custody orders), and demographics and geography.

Jurisdictional characteristic: Law enforcement agency leadership 

The predominant law enforcement agency characteristic that affected program development 

in the four studied sites was leadership style. According to those interviewed at the study 

sites, at the foundation of these preferences are law enforcement chief executives’ opinions 

about the necessity of particular personality traits among personnel for carrying out specific 

tasks. For example, many in the field report that there are senior law enforcement officials 

who believe that officers trained for the specialized response, particularly special units, 

should be volunteers, self-selected to have compassion for people with mental illnesses. 

Others may feel that all first-responders should be educated about mental illnesses and 

trained to de-escalate crisis situations using appropriate procedures. Still others believe 

that some basic training for all first-responders is in order, with more intensive preparation 

for voluntary special unit personnel. Though 

concerns about training budgets, priorities 

for limited resources, size of jurisdiction, and 

other factors may be considered in determining 

who is trained and dispatched, many of the 

individuals interviewed in the study sites felt that 

the perspective of the agency’s leaders largely 

determined how the response would be shaped.

Tailored Responses

Each of the four jurisdictions developed training 

approaches that were consistent with the agency 

leader’s style. This was most notable in the regional 

New River Valley CIT program, where variation 

exists among the police leadership in the fourteen 

jurisdictions involved in the program. Each 

jurisdiction determines which and how many of 

its officers will be trained, resulting in differences 

among them. Leaders in the Los Angeles Police 

Not all officers can be CIT 

officers, because it requires 

a personal commitment and 

compassion that cannot be 

taught or forced. Still, because 

the skills are so generalizable, 

they can be applied, in part, 

on calls such as responding to 

people with mental retardation 

and developmental disabilities, 

domestic violence calls, or 

people who are intoxicated—

all officers should have a basic 

understanding of them.” 

—Lt. Richard Edwards

Public Information Officer, Akron 

(Ohio) Police Department
From the Field: Program Design in Action 35

Department chose to provide some training on mental 

health issues to all patrol officers (twenty-four hours) 

because all officers must be prepared to handle the 

wide range of calls to which they respond. This agency 

also provides a full forty hours of “specialized” training 

to officers involved in its MEU, SMART, and CAMP 

strategies, and officers who receive CIT training for use 

in designated areas of the city. 

Jurisdictional characteristic: Law enforcement agency 

use-of-force protocols

Department policies and practices on the use of force, 

particularly less-lethal technologies, also can play a 

role in program design. Police agencies must develop 

policies on how and when officers use a range of force 

options through a complex and careful process that takes 

into account factors such as officer training and the 

circumstances during the encounter. Many communities 

are grappling with the use of conducted energy devices 

(CEDs), such as Tasers,TM during encounters with people 

with mental illnesses as a way to reduce the likelihood of 

serious injury or death during these incidents. 

Tailored Responses

These policies differed significantly across jurisdictions 

visited for this study. For example, at the time of the 

site visits, the Akron Police Department provided CEDs 

only to CIT-trained officers, and the Fort Wayne Police 

Department never provided them to CIT officers. These 

policies have since changed, but the thinking behind 

these early policies on CEDs can be instructive for other 

agencies. Akron believed that the training provided to 

CIT officers uniquely positioned them either to use the 

device very judiciously or to de-escalate a situation so that 

a CED would not be needed. (Since the time of the visit, 

Akron has extended the use of CEDs to other officers 

with proper training.) In contrast, Fort Wayne believed that 

officers trained in CIT would be the least likely to need the 

device due to their training in de-escalation and that backup 

could be provided by another patrol officer on the scene. Fort 

Wayne Police Department leaders have since decided that 

TasersTM are critical to the success 

and safety of CIT. Although 

applying CIT knowledge and 

communications skills are 

highly effective at de-escalation, 

no technique is 100 percent 

reliable. Having a less-lethal 

option available to CIT officers 

is an obvious way to increase 

everyone’s safety in handling 

many crisis calls. This is especially 

true considering that a significant 

number of these calls involve 

suicides-in-progress, and TasersTM 

may provide one of the few 

options to safely stop individuals 

from harming themselves. The 

conversation about less-lethal 

devices must be tied in with the 

CIT conversation.” 

—Sgt. Michael Yohe

CIT Coordinator, Akron (Ohio) 

Police Department

Though the Fort Wayne Police 

Department did not prioritize 

TasersTM for CIT officers, in part 

because they could be provided 

backup by other officers, they 

now have the same opportunity 

to request and train for the use of 

these less-lethal devices.”

—Deputy Chief Dottie Davis

Director of Training, Fort Wayne (Ind.) 

Police Department 
36 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

CIT training will not be a determining factor when 

selecting who in the department will be issued a 

CED. 

If a department’s leadership team decides 

that CEDs can make situations involving people 

with mental illnesses safer for all involved, law 

enforcement should work with their partners to 

develop protocols and policies, appropriate training, 

and supervision.35

Jurisdictional characteristic: Mental health 

resources

Specialized policing response programs hinge on the 

availability of mental health resources to serve as an 

alternative to criminal justice system involvement 

when warranted. Although some communities 

manage to increase the available mental health 

resources, or shift them, many communities must 

work with what resources are available in their 

jurisdiction. As a consequence, stakeholders must 

develop strategies to manage increases in volume that 

result from law enforcement transports or referrals. 

Among the issues to be considered are whether any 

changes can be made in triaging to ensure the highest 

levels of care match those most in need, evaluating 

admission criteria and accessibility issues, easing 

contact and increasing efficiency for law enforcement 

personnel, and addressing any commensurate 

increases in costs related to caring for people with 

mental illnesses at risk of continued criminal justice 

involvement, many of whom are uninsured. 

Tailored Responses

In Los Angeles and New River Valley, specialized 

policing response programs reduce some demands 

on limited mental health resources by relying on 

35. For more information about standards and guidelines for CED use, the Police Executive Research Forum 

(PERF), with support from the Office of Community Oriented Policing Services (COPS Office), has created a 

resource on the topic. See James M. Cronin and Joshua A. Ederheimer, Conducted Energy Devices: Development of 

Standards for Consistency and Guidance (Washington, DC: U.S. Department of Justice, Office of Community Oriented 

Policing Services and Police Executive Research Forum, 2006), www.ojp.usdoj.gov/BJA/pdf/CED_Standards.pdf. 

The main problem in Los 

Angeles is a lack of available 

resources—even trained officers 

have nowhere to transport 

individuals. Not only can 

the officers not transport 

anyone, there are no services to 

recommend to family members 

anymore. Psychiatric emergency 

rooms and psychiatric inpatient 

units are located in the county 

hospital, and one county 

hospital has closed completely.”

—Nancy Carter

Executive Director, NAMI–Urban 

Los Angeles (Calif.)

The number of scenarios that 

involve custody was a lot 

more before the CIT training. 

Officers can now better identify 

people who need to be taken 

into custody because they 

know what to look for. Fewer 

people are taken into custody, 

and more people are taken 

appropriately.” 

—Officer Danny Ratcliffe

CIT Officer, Pearisburg (Va.) 

Police Department (NRV)
From the Field: Program Design in Action 37

well-trained officers and effective information-gathering 

to help properly assess individuals’ need for emergency 

evaluations, and whenever possible, connect people 

with care providers outside of the emergency response 

networks. As mentioned previously, in Los Angeles, the 

SMART officers work with their triage unit to access a 

database with an individual’s history while the forensic 

nurse in this unit can access the mental health records. 

In the New River Valley, CIT officers are trained to 

screen people for the need for hospitalization, so fewer 

people are taken into custody. In both jurisdictions, 

law enforcement is working with the mental health 

community to make the most of limited resources.

In one hospital in Fort Wayne, the volume of mental 

health patients increased significantly as a result of 

the implementation of the CIT program. The number 

of twenty-four-hour mental health assessment holds 

brought to the hospital by police doubled—from 600 

in 1998 to 1,200 in 2007. The stakeholders in this 

community also eventually determined that a subgroup 

of people had been invoking a seventy-two-hour hold 

repeatedly when they did not have a mental illness. 

These individuals had primary substance abuse issues 

and many were attempting to avoid arrests for DUI. 

The facility arranged with the judge who oversees the 

commitment hearings to limit the number of times a 

person could be admitted consecutively based on an 

emergency custody order to eliminate those who were 

not in need of mental health treatment. This resulted 

in increased availability of services for those who 

appropriately needed mental health care. 

To manage costs, the inpatient mental health 

providers in Fort Wayne have developed a mechanism to 

enroll people in benefit programs, such as Medicaid. The 

hospital contracts with a for-profit business that charges a 

fee to enroll qualified individuals in Medicaid programs. 

The contractors working at Parkview Behavioral Health 

have converted 52 percent of the people who were 

admitted without insurance to become covered by 

Medicaid, which has significantly reduced the hospital’s 

burden of providing uncompensated care.36

The biggest fear was that this 

was going to cost more money. 

Parkview became creative 

with funds and implemented 

programs—with social workers 

getting . . . Medicaid for clients—

to get the ball rolling.” 

—James White

Service Coordinator/Security 

Lead Staff, Park Center Inc. 

(Fort Wayne, Ind.)

The other issue that providers 

need to be aware of is that this 

will impact their payer mix—

many people in this population 

are underinsured or not insured. If 

you are using the ER as the access 

point, this can be costly.” 

—Chuck Clark

Executive Director, Parkview 

Behavioral Health (Fort Wayne, Ind.)

Clinicians now recognize the 

CIT officer and take more stock 

in what a CIT officer is saying. 

The clinicians also recognize the 

added benefit that the officer 

provides by de-escalating the 

situation before the clinician gets 

there.”

—Deputy Chip Shrader

Montgomery County (Va.) 

Sheriff’s Office (NRV)

36. For more information about connection to federal benefits, particularly for people with mental illnesses 

who are returning to the community from prison or jail, see www.reentrypolicy.org/issue_areas/reentry_

federal_benefits.
38 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Although the communities visited were 

not able to create entirely new mental health 

resources, they were successful in maximizing the 

use of existing resources through two particular 

strategies: First, planners stretched resources 

by training officers and others to identify more 

accurately those people who needed emergency 

mental health services. Second, planners 

developed strategies to enroll qualified individuals 

in benefits programs to improve payment of 

needed mental health services. In the New River 

Valley, law enforcement agencies also shared 

resources throughout the region, making it easier 

to access and sustain them. 

Jurisdictional characteristic: Medical clearance requirements

In the New River Valley and in Fort Wayne, mental health system stakeholders were hesitant 

to accept someone into a mental health facility who might have a medical condition that 

requires priority treatment. This concern is shared by many communities across the country, 

and program models typically require law enforcement officers to transport the person in 

mental health crisis first to a hospital emergency room for medical clearance. In these cases, 

mental health services are provided after a physician determines the person is well enough 

for psychiatric assessment. 

The necessity of medical clearance requires program planners to develop procedures to 

guarantee a safe and timely medical assessment, to ensure the safety needs of other patients 

and staff, and to create a smooth transition to the appropriate mental health resource. 

Tailored Responses

In Fort Wayne, law enforcement officers bring the person in crisis to the emergency room 

of the local hospital through the ambulance entry to one of three secure rooms. This allows 

privacy and security. The individuals in the care of officers get priority treatment and 

officers talk directly with the mental health counselors. Once the physician determines the 

individual’s medical condition is stable, the mental health clinicians assess the needed level 

of care.

To enable officers to return to other duties, the hospitals in Fort Wayne employ security 

staff to monitor the patient’s safety and the safety of others in the emergency room. The 

hospital worked with their legal counsel to develop clear guidelines on holding, restraining, 

and detaining patients, and to make sure that hospital security is not held liable for injuries 

that may result. Although the goal in these hospitals is to err on the side of protecting 

patients from harming themselves or others, their care, dignity, and privacy were considered 

in developing these guidelines. 

The biggest challenge is 

bringing all the people in 

through the ER. The ER was 

identified as the access point 

for all psychiatric patients; it 

is expensive and not best for 

patients to have to wait three or 

four hours for an assessment.” 

—Chuck Clark

Executive Director, Parkview 

Behavioral Health (Fort Wayne, Ind.)
From the Field: Program Design in Action 39

Jurisdictional characteristic: State laws

Requirements in state laws regarding law enforcement 

officers’ role in emergency mental health evaluations 

must be addressed in designing and implementing 

specialized policing responses. These laws may affect 

program design by mandating certain types or the 

scope of training. They can also spell out under what 

circumstances officers are permitted to transport or 

take into custody individuals with mental illnesses who 

meet specific standards (such as imminent harm to 

themselves or others).

Among the many state mandates that can affect 

program design, the one that was most at issue in 

the four-site study involved officers taking custody 

of individuals with mental illnesses for emergency 

evaluation. As described, in Virginia, for example, a 

law enforcement officer is authorized to determine if 

a person meets the criteria for an “emergency custody 

order” (ECO) without taking the person in front of a 

magistrate. The ECO lasts up to six hours (previously 

mandated at four hours), and state law requires that 

the officer maintain custody of the person with mental illness while they wait for a mental 

health crisis worker to arrive and complete a mental health assessment, and find a treatment 

bed if needed. Officers may not detain the person in jail during this time, which means law 

enforcement agencies must designate a place where the officer can stay with the person in 

crisis until a clinician arrives. Oftentimes, this space becomes a multipurpose room (the 

same area may serve as a waiting area for a person who has been served a warrant and for 

someone who has come to the department to report a crime). If the six-hour period elapses 

without an assessment or an available place for treatment, the person must be released. 

During the ECO time period, crisis workers assess the person’s status, gather collateral 

information, and decide if the person meets the criteria to be committed. If the criteria are 

met, the clinician tries to facilitate an admission to an inpatient facility—either into a public 

or private facility—or diverts the individual back to the community to receive services and 

supports. The majority of the calls are handled within the six-hour period. 

Tailored Responses

One goal of the New River Valley CIT program is to address the strain on law enforcement 

personnel created by this law. At this writing, there is legislation in place in Virginia that 

would allow for a CIT officer to be stationed in the hospital emergency room to accept 

custody of the incoming person in mental health crisis, and allow the transporting officers to 

return to patrol. Alternatively, if the hospital has a police or security department of its own, 

In 2008, hospitals were faced 

with national patient safety goal 

#15, which requires a system for 

screening patients for suicide 

risk. They must be screened 

appropriately and the hospital 

must provide ‘continuity of care’ 

so that when the person returns 

to the community it must be with 

a safety net in place.

Mental health clients are no 

longer what we do at the end of 

the day when we are done with 

everything else. This hospital is 

now making psychiatric services a 

priority and we are committed to 

quality services.” 

—Deb Richey

Nursing Director of Emergency 

Services, Parkview Hospital 

(Fort Wayne, Ind.)
40 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

the new legislation allows “willing and able” 

hospital security staff to extend their duties to 

include managing the ECO process.37

For law enforcement officers in Fort Wayne, 

the ECO under state law has been limited to 

a twenty-four-hour hold and it has been an 

effective tool for reducing the time officers 

spend waiting at community facilities with 

people who need a mental health assessment. 

This statute was originally underutilized 

because officers were not comfortable making 

decisions regarding mental health assessment 

criteria. Now that they have received specialized 

training on the issue, they are more likely to 

invoke the ECO law that authorizes them to 

transport that person to the emergency room 

without the officer needing to retain custody. 

Although this ECO is designed primarily for 

medical observation, it can be converted into a 

seventy-two-hour commitment for mental health 

evaluation upon judicial order. 

PROGRAM EXAMPLE: Working collaboratively to meet legal guidelines, 

Lincoln (Nebr.)38

In Nebraska, law enforcement and correctional officers are the only authorities who can 

take people into emergency protective custody (EPC) for involuntary mental health evaluation. Within thirty-six hours, a county attorney will determine whether to proceed with the 

involuntary commitment process. Nebraska is divided into six regions, each of which has a 

dedicated facility to receive people placed into EPC by law enforcement. Police officers in the 

City of Lincoln have round-the-clock access to mental health professionals in their region to 

assist them in deciding whether the person warrants custody or to determine an appropriate alternative. The Lancaster County Mental Health Agency, which serves Lincoln, is available 

24/7 either by phone, in-person in the field, or at the police station. The officer can also take 

individuals directly to the mental health agency during business hours.

The City of Lincoln has also created a new process that has reduced by half the number of 

EPC orders officers do in a year. The key is to provide information to officers in the field about 

consumer involvement in programs like Assertive Community Treatment (ACT) to maintain 

their connection to these programs. Consumers can sign a waiver to put their participation 

in ACT in a police database. When officers conduct a routine warrant search, they get a message to contact the person’s case manager, rather than taking the person into the emergency 

mental health system, where they will have to start over.

37. At press time, this legislation had been passed and the leadership in New River Valley were working toward 

implementing this practice.

38. The information presented in this program example was developed based on a phone interview conducted 

during the information-gathering phase of this project. For more information about the Lincoln Police 

Department’s efforts, see the profile available on the Local Programs Database at www.cjmh-infonet.org/main/

show/2103.

There was a statutory twentyfour-hour hold on the books 

since 1969. The reason it was not 

used was because police officers 

were not trained. Before CIT, 

officers had to wait hours with 

the person in crisis until a mental 

health professional could come 

and conduct the assessment. 

Now, along with CIT, we are 

using this hold so that officers 

have the authority to take the 

person to a mental health facility 

for assessment, where better 

procedures reduce the amount of 

time officers must wait with the 

person. This has added a great 

efficiency to our processes.” 

—James White

Service Coordinator/Security 

Lead Staff, Park Center Inc. 

(Fort Wayne, Ind.)
From the Field: Program Design in Action 41

Jurisdictional characteristic: Demography and 

geography

A jurisdiction’s population size and density, land area, 

traffic patterns, and crime problems present important 

constraints on specialized responses. Jurisdictions of 

all sizes, particularly those at either end of the range, 

struggle with the adequacy of community-based 

resources, the ease of accessing them, and the allocation 

of officers to work with them. 

Tailored Responses

In Los Angeles, one of the strategy impetuses was 

concern over safety for all individuals involved in 

police encounters, which resulted in recommendations 

to implement CIT. However, the size of the police 

department limited the agency’s ability to train the 

recommended benchmark of 20 percent of the officers 

to work full time on crisis intervention calls.39 The 

jurisdiction’s large geographic area also made deploying 

the CIT-trained officers difficult. They found during pilot 

testing in one area that the 20 percent of the officers 

they were able to train in just that district still were 

only able to respond to 20 percent of the calls involving 

people with mental illnesses. In large part, this occurred 

because transportation to psychiatric emergency centers 

kept CIT officers in the hospital for three to four hours, 

unable to respond to other mental health calls.

In response, LAPD tailored its strategy to focus 

on the co-response model—increasing the number of 

personnel assigned to SMART and expanding the hours 

of operation. The co-responder teams are assigned 

to patrol areas with overlapping response protocols, which ensures citywide coverage. The 

linchpin to this strategy is the MEU “triage desk,” with staff that provides advice to primary 

responders, dispatches SMART units, controls the flow of individuals who have received 

law enforcement responses to county psychiatric emergency departments, and maintains a 

database of law enforcement contacts. In addition, Los Angeles decided to train all officers 

with twenty-four hours of online training on crisis intervention tactics, and the department 

offers a CIT course each quarter that is open to all first-responders, although priority is 

given to those officers most likely to encounter people with mental illnesses. This training 

39. The recommendation to train 20 to 25 percent of a law enforcement agency is proposed by the CIT Center 

at the University of Memphis in the “Crisis Intervention Team Core Elements,” http://cit.memphis.edu/

CoreElements.pdf.

[One] reason larger cities are 

challenged to maintain CIT is 

because geography and the 

sheer number of calls to which 

they must respond can prohibit 

relationship-building. With 

three county hospitals, CIT 

police officers are unable to form 

necessary relationships with 

hospital personnel because they 

are limited by time.” 

—Linda Boyd

Manager of Law Enforcement Mental 

Health Programs, Department of 

Mental Health, Los Angeles County 

(Calif.)

My officers can spend up to twelve 

hours on night shift dealing with 

a call involving a mental health 

assessment. This is the biggest 

problem our small department 

faces. If we get taken on a call like 

that, a whole shift is off-road all 

night and we may only have two 

or three deputies on duty.” 

—Chief Jackie Martin

Pearisburg (Va.) Police Department 

(NRV)
42 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

is a key component of LAPD’s strategy because 

any officer may encounter someone whose mental 

illness is a factor in the call for police involvement. 

The department’s leaders believed all officers would 

benefit from knowledge of these techniques. So the 

LAPD based its decisions to build a multi-tiered 

response model on the size of the jurisdiction, data 

that identified a particular geographic area that 

generated repeat calls for service, leadership style, and 

many of the other characteristics discussed previously.

The New River Valley CIT brought together 

fourteen jurisdictions in its area because they all fell 

within one of Virginia’s mental health catchment 

areas.40 The goal of bringing the smaller, rural 

communities together was to capitalize on shared 

resources. For example, agencies created agreements 

to allow officers to cross jurisdictions and serve each 

other’s residents, and planned to train 25 percent of 

the total number of patrol officers from the combined 

forces to have sufficient coverage of shifts and 

geography. 

In New River Valley, these communities have 

focused on developing better relationships between 

law enforcement and consumers of mental health 

services. Because of the CIT program and officer 

training, stakeholders note that consumers are less 

reluctant to interact with law enforcement officers, are 

less fearful of officers, and even recognize CIT officers 

as helpful. Although this improved relationship may 

not change the fact that law enforcement must stay 

with the person for up to six hours, and may not have 

a nearby facility to take them, it does help officers 

communicate with consumers and understand how to 

resolve problems. According to those interviewed in 

the study site, the improved rapport and trust between 

officers and clinicians, consumers, and citizens who 

call for assistance has also boosted the credibility of 

law enforcement observations in the eyes of mental 

health professionals. 

One of the advantages to large 

jurisdictions is that there are 

many resources to tap and many 

community members to assist 

and many officers committed to 

working with this population.”

—Chief William Bratton

Los Angeles (Calif.) Police Department

40. Because mental health services are organized along different geographic lines than law enforcement 

services, it can be difficult to develop coordinated service delivery strategies. Jurisdictions need to consider 

their respective catchment areas when setting up collaborative initiatives.

The very nature of the rural 

community creates challenges—

the distances are long and 

there is almost no public 

transportation [to help people 

access services easily].”

—Harvey Barker

Director, New River Valley (Va.) 

Community Services (NRV)

It used to be mental health on 

one side, law enforcement on 

the other. They looked at us 

as yanking people out, and we 

looked at them and thought: 

I’ve had to fight this guy to get 

him to the department and you 

want to be all touchy feely. The 

trip we all took to Memphis 

brought us together and created 

a lasting bond. We gained a lot 

of respect for each other during 

that time.”

—Deputy Chip Shrader

Montgomery County (Va.) 

Sheriff’s Office (NRV)
From the Field: Program Design in Action 43

PROGRAM EXAMPLE: Tailoring to a large rural region, 

Piscataquis County (Maine)41

Piscataquis County (Maine) is the only “frontier county” east of the Mississippi. According to 

Sgt. Robin Gauvin of the Portland, Maine, Police Department, this equates to a population 

density of less than one person per square mile. This county has three municipal police departments that determined a need to improve their response to people with mental illness in this 

rural area. This program has focused on creating force multipliers to boost the law enforcement response capacity. 

For example, in 2003 the law enforcement agencies began partnering with Emergency 

Medical Services so that ambulances co-respond with police on situations involving someone 

with a mental illness. When an area has only one deputy in charge of 400 square miles, this 

agreement translates to the addition of three or four emergency medical technicians who can 

be called upon to assist. The involvement of the ambulance staff assists with de-escalation 

and transportation. The officer can arrive at a scene within ten minutes and an ambulance 

can arrive in twenty to thirty minutes, but mobile crisis workers would take more than an 

hour to reach most areas. Call takers and dispatchers are also part of expanding capacity to 

respond. They are now trained to ask for more information, give options to help, and ask questions once thought dangerous to ask a caller expressing thoughts of suicide.

Conclusion

SPR program development should be guided by both the problem in the community and 

the specific characteristics of the jurisdiction. There is no “one-size-fits-all” response that 

will work in every community. It is vital that leaders in law enforcement, mental health, 

and consumer advocacy understand what obstacles there are to providing sensitive and 

appropriate responses to people with mental illnesses, and then assess what resources and 

agency strengths can overcome them. 

The program activities presented in this guide hint at the efforts being made around 

the country to improve law enforcement responses to people with mental illnesses. They 

should not be considered a complete catalog of all possible options, but rather are included 

to highlight common themes and promising approaches to problems faced by agencies with 

varying demographics. The examples from the sites, and the discussions of selected problems 

and factors that should influence program planning, are provided to underscore the need 

to truly understand what responses will make the most sense in a particular jurisdiction. It 

is hoped that policymakers and planners from any agency can use this guide as a starting 

point to design or enhance a SPR program that will result in better outcomes for people 

with mental illnesses, a more effective and rewarding use of law enforcement resources, and 

improved safety of all involved in these encounters. 

41. The information presented in this program example was developed based on a phone interview conducted 

during the information-gathering phase of this project. For more information about the Piscataquis Sheriff’s Office 

Crisis Intervention Team, see the profile available on the Local Programs Database at www.cjmh-infonet.org/

main/show/3137.

Appendix A: Site Visit Information 45

Appendix A

Site Visit Information

Titles and agency affiliations reflect the positions held at the time the interviews were 

conducted.

Akron (Ohio)

Site Visit Dates: December 5–7, 2007 

Interviews Conducted

• Chief Michael Matulavich, Akron Police Department

• Lieutenant Richard Edwards, Public Information Officer, Akron Police Department

• Lieutenant Mike Woody (retired), Law Enforcement Liaison, Ohio Criminal Justice 

Coordinating Center of Excellence

• Sergeant Michael Yohe, CIT Coordinator, Akron Police Department 

• Officer Lori Natko, CIT Officer, Akron Police Department

• Officer Forrest Kappler, CIT Officer, Akron Police Department

• Ms. Lorie Witchey, Dispatcher, Akron Police Department

• Dr. Mark Munetz, Chief Clinical Officer, Summit County (Ohio) Alcohol, Drug 

Addiction and Mental Health Services Board

• Kim Shontz, Director of Outpatient Services, Community Support Services

• Joan “Ragan” Leff, CIT Coordinator, Community Support Services

• Ron Rett, Member, NAMI–Ohio

• Mel and Helen Reedy, Members, NAMI–Ohio

• Bernie, Consumer

Fort Wayne (Ind.)

Site Visit Dates: February 20 –21, 2008 

Interviews Conducted

• Deputy Chief Dottie Davis, Director of Training, Fort Wayne Police Department

• Officer Mark Bieker, CIT Officer, Fort Wayne Police Department

• Teresa Hatten, President, NAMI–Indiana

• Jane Novak, Member, NAMI–Indiana

• Deb Richey, Nursing Director of Emergency Services, Parkview Hospital (Fort Wayne)

• Marcy Malloris, Transitional Care Services Manager, Park Center Inc. (Fort Wayne, Ind.)

• James White, Service Coordinator/Security Lead Staff, Park Center Inc. (Fort Wayne, Ind.)
46 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

• Chuck Clark, Executive Director, Parkview Behavioral Health (Fort Wayne)

• Patsy Hendricks, Director of Clinical Services, Parkview Behavioral Health (Fort Wayne)

• Amy Tyler, Director of Behavioral Health, St. Joseph Hospital (Fort Wayne) 

• Joe Louraine, Assessment Specialist, St. Joseph Hospital (Fort Wayne) 

• Andy Wilson, Executive Director, Carriage House (Fort Wayne)

• Tom, Consumer, Carriage House (Fort Wayne)

• John, Consumer, Carriage House (Fort Wayne)

• Joe, Consumer, Carriage House (Fort Wayne)

Los Angeles (Calif.)

Site Visit Dates: December 11–14, 2007

Interviews Conducted

• Chief William Bratton, Los Angeles Police Department

• Assistant Chief Jim McDonnell, 1st Assistant Chief, Chief of Staff, Los Angeles 

Police Department

• Assistant Chief Earl Paysinger, Director, Office of Operations, Los Angeles 

Police Department

• Commander Harlan Ward, Assistant Commanding Officer of Valley Bureau, 

Los Angeles Police Department 

• Captain Ann Young, Commanding Officer, Detective Support and Vice Division, 

Los Angeles Police Department

• Lieutenant Rick Wall, Mental Evaluation Unit, Los Angeles Police Department

• Lieutenant Michael Albanese (ret.), SWAT Commander, Los Angeles Police Department

• Detective Teresa Irvin, CAMP Coordinator, Los Angeles Police Department

• Dr. Luann Pannell, Director of Police Training and Education, Los Angeles 

Police Department

• Dr. Tony Beliz, Deputy Director, Emergency Outreach Bureau, Department of 

Mental Health, Los Angeles County 

• Linda Boyd, Manager of Law Enforcement Mental Health Programs, Department of 

Mental Health, Los Angeles County 

• Nancy Carter, Executive Director, NAMI–Urban Los Angeles 

• Jim Randall, President, NAMI–San Fernando Valley 

• Mark Gale, Member, Board of Directors, NAMI–California 
Appendix A: Site Visit Information 47

New River Valley (Va.)

Site Visit Dates: March 6–7, 2008

Interviews Conducted

• Victoria Cochran, Chair, State Mental Health, Mental Retardation and 

Substance Abuse Services Board

• Chief Jackie Martin, Pearisburg Police Department

• Chief Gary Roche, Pulaski Police Department

• Lt. Brad St. Clair, Montgomery County Sheriff’s Office

• Deputy Chip Shrader, Montgomery County Sheriff’s Office

• Officer Danny Ratcliffe, CIT Officer, Pearisburg Police Department

• Patrick Halpern, Executive Director, Mental Health Association of the 

New River Valley, Inc.

• Dr. Harvey Barker, Executive Director, New River Valley Community Services

• Marie Moon Painter, Clinical Team Leader for CONNECT, Carilion St. Albans 

Behavioral Health

Appendix B: Document Development 49

Appendix B

Document Development 

This document was developed based on information gathered in several communities 

throughout the country, which were selected to represent a range of characteristics—diverse 

objectives, jurisdiction sizes, and program models. The site selection process began with an 

in-depth review to identify jurisdictions with an active law enforcement-based specialized 

response program—including mining the Local Programs Database, examining literature 

published on existing programs, and consulting with national experts. Once a comprehensive 

list was compiled, programs were screened for inclusion based on three important features—

the program had to be law enforcement-based, in existence for at least five years, and designed 

independently based on the jurisdiction’s specific circumstances.

Why these three characteristics?

1) Many communities have developed teams of community mental health professionals, 

such as mobile crisis or assertive community treatment teams, to assist officers at 

the scene. Although these models are undoubtedly a valuable resource for many 

communities and departments, they do not require significant policy and procedural 

changes in the law enforcement agency, and therefore are not law enforcement-based

and are not within the scope of this document.

2) Anecdotal evidence suggests that during the first five years of an initiative, program 

practices and policies undergo an iterative process of development, building on the 

program’s successes and failures over time. Based on this finding, jurisdictions needed 

to have an operational program for at least five years to be considered.

3) Several state governments have coordinated efforts to proliferate a specific model 

throughout jurisdictions in their state. These states should be applauded for these 

efforts, but jurisdictions that selected and implemented a program based on state 

policymakers’ influence did not go through an independent program design process. 

Because the intention of this report is to identify and describe the various methods 

of program design, only jurisdictions that designed the program based on specific 

circumstances and characteristics were included.
50 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

The initial screening process left a short list of jurisdictions that fit the three primary 

criteria. Interviews were conducted with representatives from the remaining programs, and 

were centered on four main questions:

1. How was the program developed? 

2. Is there a priority population involved in the strategy?

3. What is the nature and strength of the criminal justice/mental health collaboration? 

4. How are data collected and analyzed?

Information gleaned from these telephone interviews was considered in the context 

of remaining selection criteria: variation in program model and jurisdiction type (e.g., 

demographic features and geography), mental health delivery styles, field familiarity (e.g., 

highlighting less-known programs), and usefulness and applicability to the field. Based on 

this review process, Akron (Ohio), Fort Wayne (Ind.), Los Angeles (Calif.), and New River 

Valley (Va.) were selected to be visited for this report.
Appendix C: Program Design Worksheet 51

Appendix C

Program Design Worksheet

Step 1: Understand the problem

1. What forces are driving current efforts to improve the law enforcement response to 

people with mental illnesses? 

2. What data can planning committee members examine to understand the factors 

influencing law enforcement responses to people with mental illnesses?

3. What are the data limitations, and how can they be overcome? 

Step 2: Articulate program goals and objectives

1. What are the program’s overarching goals?

2. What are the program’s objectives? 

Step 3: Identify data-collection procedures needed to revise and 

evaluate the program 

1. What data will be collected to measure whether goals and objectives 

have been achieved? 

2. What data collection strategies will be used? 

Step 4: Detail jurisdictional characteristics and their influence on 

program responses 

1. What characteristics of the law enforcement agency are relevant in planning a 

specialized response to people with mental illnesses?

2. What mental health system characteristics are relevant in planning a specialized 

response to people with mental illnesses?

3. What state laws are relevant in planning a specialized response to people with mental 

illnesses? 

4. What demographic and geographic community characteristics are relevant in planning 

a specialized response to people with mental illnesses? 
52 Tailoring Law Enforcement Initiatives to Individual Jurisdictions

Step 5: Establish response protocols

1. What law enforcement responses are necessary? 

2. What mental health system responses are necessary?

3. What other responses or resources are necessary? 

Step 6: Determine training requirements

1. How much training will be provided and to which law enforcement personnel? 

2. What topics should training cover? 

3. Who will provide the training? 

4. What training strategies will be employed?

Step 7: Prepare for program evaluation

1. What resources need to be set aside or identified for an evaluation?

2. Are there individuals designated to oversee the evaluation?

Council of State Governments

Justice Center

www.justicecenter.csg.org