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The effect of crisis intervention team training on the outcomes of mental health crises calls for law enforcement

Dissertation
Author: Joshua Adam Thomas Acker
Abstract:
In the United States, law enforcement officers frequently manage encounters with people who are experiencing mental health crises. The crisis intervention team (CIT) training prepares officers for handing situations that involve people with mental illnesses, and communities are adopting CIT programs. Proponents of CIT training theorize that it improves outcomes for those in mental health crises, such as diversion from jail, improved safety, and increased mental health referral. The sequential intercept, which provides the theoretical foundation for this study, identifies five opportunities when people with mental illnesses can be diverted from the criminal justice system. The model's first intercept point is law enforcement discretion in potential arrest situations. However, there is a scarcity of empirical research addressing the impact of CIT training on arrest outcomes The purpose of this quasi-experimental study was to examine whether CIT trained officers differ from officers who are not CIT trained on use of force, number of injuries to officer, number of injuries to those in crisis, and the disposition of these service calls. Archival data from one sheriff's office were utilized for this analysis; data included 450 deputy sheriffs and encompassed 4,453 incidents. Data were analyzed using MANOVA, ANOVA, Kruskal-Wallis, and Kendall's Tau b. Small but statistically significant differences were found between CIT and those not CIT trained deputies. CIT trained officers were associated with lower rates of injury to citizens in mental health calls and were more likely to provide mental health referrals. This research contributes to social change by documenting the need for specialized law enforcement training and the positive impact it may have on people with mental illnesses.

Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1 ..............................................................................................................................1 Definitions............................................................................................................... 4 Background of the Problem ...........................................................................................7 Mental Illness and the Criminal Justice System ..................................................... 8 Florida CIT Coalition ............................................................................................ 14 History of CIT in Pinellas County ........................................................................ 15 Statement of the Problem .............................................................................................16 Nature of the Study ......................................................................................................17 Research Questions and Hypotheses .................................................................... 17 Research Questions ............................................................................................... 18 Hypotheses ............................................................................................................ 18 Purpose of the Study ....................................................................................................19 Theoretical Considerations ..........................................................................................20 Assumptions, Limitations, and Scope ..........................................................................21 Significance of Study ...................................................................................................24 Summary ......................................................................................................................25 Chapter 2: Literature Review .............................................................................................28 Overview ......................................................................................................................28 Literature Search Strategy............................................................................................29

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Introduction to CIT ......................................................................................................30

The Memphis Model CIT Program....................................................................... 31 Research Comparing CIT to Other Models .................................................................33 CIT Research and Law Enforcement Attitudes and Knowledge .................................35 General Population Attitudes ................................................................................ 35 Law Enforcement Attitude Studies ....................................................................... 37 Anger and Aggression........................................................................................... 39 Knowledge Retention Study ................................................................................. 41 CIT Effectiveness Research .........................................................................................42 Memphis Tennessee Study ................................................................................... 43 The Akron Ohio Study .......................................................................................... 44 Albuquerque New Mexico Study .......................................................................... 47 The Louisville, Kentucky Study ........................................................................... 48 Court Decisions Related to CIT ...................................................................................49 Summary ......................................................................................................................51 Chapter 3: Research Methods ............................................................................................54 Research Design and Approach ...................................................................................55 Research Design.................................................................................................... 55 Appropriateness of Design .................................................................................... 56 Research Questions and Hypotheses ...........................................................................56 Main Research Question ....................................................................................... 57 Main Hypothesis ................................................................................................... 57

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Research Question 1 ............................................................................................. 57

Hypothesis for Question 1 .................................................................................... 58 Research Question 2 ............................................................................................. 58 Hypothesis for Question 2 .................................................................................... 58 Research Question 3 ............................................................................................. 58 Hypothesis Question 3 .......................................................................................... 59 Research Question 4 ............................................................................................. 59 Hypothesis for Question 4 .................................................................................... 60 Setting and Sample ......................................................................................................60 Participants ............................................................................................................ 60 Sampling Method .................................................................................................. 61 Power Analysis ..................................................................................................... 62 Treatment .....................................................................................................................62 Research Instruments and Procedures .........................................................................64 Measures ......................................................................................................................65 Data Collection and Analysis.......................................................................................66 Research Questions ............................................................................................... 66 Data Collection ..................................................................................................... 66 Analytical Procedures ........................................................................................... 71 Participant Privacy and Ethical Considerations ...........................................................72 Summary ......................................................................................................................73 Chapter 4: Results ........................................................................................................74

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Demographics ..............................................................................................................74

Tests of Normality ................................................................................................ 76 Main Research Questions ..................................................................................... 83 Box’s M ................................................................................................................ 84 MANOVA Test ..................................................................................................... 84 Hypothesis 1: Arrest Rate ..................................................................................... 86 ANOVA of Hypothesis 1: Arrest Rate ................................................................. 86 Kruskal-Wallis Analysis of Hypothesis 1: Arrest Rate ........................................ 87 Hypothesis 2: Mental Health Referral Rate .......................................................... 88 ANOVA of Hypothesis 2 ...................................................................................... 88 Kruskal-Wallis Analysis of Hypothesis 2 ............................................................. 89 Kendall’s Tau b of Hypothesis 2 .......................................................................... 90 Hypothesis 3: Use of Force ................................................................................... 90 ANOVA Analysis of H3 ....................................................................................... 91 Kruskal-Wallis Analysis of H3 ............................................................................. 92 Hypothesis 4: Suspect Injury Rate ........................................................................ 92 ANOVA Analysis of Hypothesis 4 ....................................................................... 92 Kruskal-Wallis Analysis of Hypothesis 4 ............................................................. 93 Kendall’s Tau b of Hypothesis 4 .......................................................................... 94 Summary ......................................................................................................................94 Chapter 5: Discussion, Conclusions, and Recommendations ............................................96 Interpretation of Findings ............................................................................................98

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Arrest ................................................................................................................... 98

Referral of Individuals in Mental Health Crisis .................................................... 99 Use of Force ........................................................................................................ 101 Injury Rates ......................................................................................................... 102 Effects of Age and Tenure .................................................................................. 102 Implications for Social Change ..................................................................................103 Recommendations for Action ....................................................................................106 Recommendations for Further Study .........................................................................109 Summary ....................................................................................................................110 References ........................................................................................................................114 Appendix A: Letter of Cooperation .................................................................................122 Curriculum Vitae .............................................................................................................123

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List of Tables Table 1. Descriptive Statistics........................................................................................... 76 Table 2. Kendall’s Tau Zero-Order Correlations .............................................................. 82 Table 3. Inferential Statistics Generated From MANOVA Analysis ............................... 84 Table 4. ANOVA Analysis for Arrest Rate ...................................................................... 86 Table 5. ANOVA Analysis for Mental Health Referral Rate ........................................... 88 Table 6. ANOVA Analysis for Force Rate ....................................................................... 93

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List of Figures Figure 1. Histogram of the arrest rate .. .............................................................................78 Figure 2. Histogram of the mental health referral rate .......................................................80 Figure 3. Histogram of the force rate .................................................................................81 Figure 4. Histogram of the suspect injury rate ...................................................................82

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Chapter 1 Communities face some challenging realities concerning mental illness, treatment of mental illness, and the potential for tragedy resulting from untreated mental health issues. Tragedy can result in harm to the person who has a mental illness through an inability to care for him or herself or the desire to harm them self. Most often reports of these issues are high profile situations that result in a person with a mental illness harming someone else or the person with the mental illness being injured or killed by law enforcement officers called to resolve a mental health crisis. This is not to suggest that tragedy is a common outcome among those people diagnosed with mental illnesses. It is however, a potential in some cases of untreated severe and persistent mental illnesses. Dr. Xavier Amador (2007), a psychologist, addressed this issue in his book I Am Not Sick, I Don’t Need Help! How to Help Someone with Mental Illness Accept Treatment. Dr. Amador pointed out that family members, mental health professionals, and many others are frustrated with attempts to have people with a mental illness successfully treated. He illustrated the potential for extreme incidents of tragedy in cases such as the 1998 death of two United States Capitol police officers by Russell Weston, a man with a mental illness. Although this incident was widely publicized, more common is the potential that people with untreated mental illness become problems to themselves and their communities. The role of law enforcement officers, more specifically uniformed patrol officers, is varied and challenging in our communities. It was August Vollmer (1932), known as the father of modern policing, who characterized the role of law enforcement officers as

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more than enforcing laws and battling crime. He recognized police officers were required to address a number of community needs, and even suggested they were ―social worker[s] of the community‖ (p. 720). Vollmer wrote that police officers were not always prepared to address the diverse set of responsibilities of police work. Dealing with issues related to mental health matters can be particularly difficult. Traditionally, officers are not trained the same as mental health professionals. Therefore, they face the frustration of the challenges trying to navigate the mental health system and to obtain assistance for the persons they encounter who have mental health needs (Borum, 2000; Thompson & Borum, 2006). There is considerable evidence to suggest that encounters between officers and a person in crisis can have a tragic outcome when proper training does not exist or there are a deficiency of resources and procedures in place (Borum, 2000; Thompson & Borum, 2006). A review of the literature reveals little research examining the effectiveness of law enforcement-based programs designed to guide interactions with people who have a mental illness and those who are in crisis. There has been research into police officer perceptions of mental illness, and into effectiveness of training programs based on knowledge acquired at the conclusion of such programs (Addy, 2005; Borum & Morrissey, 2000; Borum, Dean, Steadman, & Morrisey, 1998; Compton et al., 2006; Deane, Steadman, Borum, Veysey & Morrissey, 1999; Sellers, et al., 2005; Steadman, Deane, Borum & Morrissey, 2000). However, studies assessing behavioral outcomes are less common. One program with increasing popularity utilized in various parts of the United States (U.S.) for police responses to mental health crises is the Crisis Intervention

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Team (CIT) program (Steadman et al., 2001; Teller et al., 2006; Thompson & Borum, 2006). The Memphis Model CIT program is a law enforcement operation. It consists of police officers specially trained and deployed to bring resolution in a time of crisis. This program does not employ civilian or mental health professionals to accompany officers on these types of calls, although officers may have professional resources they can call upon to assist in handling the call through consultation or referral for services (Borum et al., 1998; Cochran, Deane, & Borum, 2000). The catalyst for the CIT program occurred in 1987 in Memphis, Tennessee. Memphis police officers became involved in a confrontation with a man diagnosed with a mental illness; during this contact, they fatally shot the man. Members of the community, responding to this incident, demanded change in the way police officers interacted with people with a mental illness. The local chapter of the Alliance of the Mentally Ill (AMI), now known as the National Alliance on Mental Illness, partnered with the Memphis Police Department and developed a team concept to address this issue. The CIT program focuses on multiple areas that the police, the mental health community, and other stakeholders in mental health can work together on to more successfully serve this population with special needs. Typically, stakeholders include consumers of mental health services, family members of consumers, private practitioners, and others who have a vested interest in CIT-related issues. A significant component of the CIT program is the training program for police officers in managing their encounters with persons who may have a mental illness (Compton et al., 2006; Cochran, Deane, & Borum, 2000; Memphis Police Department, 1999; Thompson & Borum, 2006).

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Currently, there is a gap in the literature with comparisons of outcomes between CIT trained and nontrained law enforcement officers. The purpose of this study is to determine whether CIT training has an effect on outcomes of mental health referral, arrest rate, use of force rate, deputy sheriff injury rate, and injury rate to members of the public when law enforcement officers handle mental health crises calls for service. Chapter 2 of this dissertation will provide a more detailed examination of prior attempts to measure the effectiveness of police based mental health crisis intervention. Definitions It will be helpful to understand some of the terms and acronyms utilized in this study. Some of the terms are defined in this section to provide clarity to future sections and chapters of this document. The definitions section will also help with making sense of jargon, which is common to the criminal justice system. Augmented Criminal Investigative Support Systems (ACISS)-The computer software system utilized by the Pinellas County Sheriff’s Office to store data related to criminal and noncriminal events, which come to the attention of the agency’s staff. ARMS Specialist–The Automated Records Management System (ARMS) Specialist is a clerk whose responsibilities are to prepare criminal and noncriminal reports under the direction of the deputy sheriffs or other agency members who are required to document their activity in a call for service. Baker Act–This is a Florida State Statute, which specifically addresses the legal requirements, definitions, and responsibilities for the emergency treatment of people experiencing a mental health emergency.

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Computer Aided Dispatch (CAD)-This software is used to gather necessary data regarding requests for services from the public, to classify and prioritize the request. It is used to record information as to the disposition of the request, and which Communications Center, deputy sheriffs, and other personnel handled the request. Call-Taker–This is a civilian employee of the Communications Center who answers incoming emergency and nonemergency calls. These employees provide an initial classification for the requests received by the communications center for the purpose of prioritizing and dispatching appropriate personnel. Call for Service–This is a request generated by a member of the public, another law enforcement agency, or some other organization which requires the attention of a deputy sheriff to address the concern or need. Other situations, such as a deputy sheriff encountering a situation in the field can be described as a call for service if the deputy determines there is a need for services or the need for documentation of the situation or encounter. Communications Center -A division of the Pinellas County Sheriff’s Office whose members are responsible receiving requests for law enforcement, emergency calls, administrative requests, and disseminating to the appropriate personnel or dispatching the appropriate personnel to handle the situation. Crisis Call- These calls for service are of an urgent nature and require immediate attention. It often involves a person in some sort of distress. Deputy Sheriff- In the State of Florida, elected constitutional officers for each county are charged with law enforcement responsibilities for their county, and they are

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identified as Sheriff of their county jurisdiction. Deputy sheriffs are employed by and work as an extension of the Sheriff and often serve in a capacity of enforcing laws and assisting citizens and visitors of the county with a variety of emergency and nonemergency needs. Dispatcher- This classification is given to employees of the communications center who are responsible for disseminating information to deputy sheriffs in the regarding requests from citizens for assistance. Dispatchers document the activity and requests of deputy sheriffs in the computer aided dispatch system. Law Enforcement Officer- The State of Florida defines by legislative statute those government employees who are responsible for enforcing criminal laws as a part of their professional assignments. Law enforcement officers are employed by state, county, or municipal government agencies. It is common that these law enforcement officers are armed with firearms and are given the authority to carry out a variety of responsibilities from enforcing criminal laws and local ordinances to investigating situations that come to their attention. In the State of Florida, Sheriffs and Deputy Sheriffs are law enforcement officers. Marchman Act- This is a Florida State Statute, which specifically addresses the legal requirements, definitions, and responsibilities for the emergency treatment of people experiencing a mental health emergency with substance use or abuse involvement. Mental Illness- This is a medical condition affecting the human brain that results in cognitive or behavioral impairment. Mental illness is classified in many categories.

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These are listed in the American Psychiatric Association’s Diagnostic and Statistical Manual (2000). Receiving Facility- These facilities are treatment centers designated to provide care and treatment to medical, psychiatric, or medical and psychiatric conditions. The designations of these facilities are determined by the conditions they are licensed to treat by the Agency for Health Care Administration (AHCA), a regulatory agency of the State of Florida. Background of the Problem Police are often the first to respond to help during a mental health crisis in the community (Thompson & Borum, 2006). In 2004, the New York City Police Department estimated its officers responded to about 150,000 calls involving persons who had an emotional disturbance of some kind (Bureau of Justice Administration, 2007). Law enforcement officers often experience frustration in their time consuming attempts to assist people with a mental illness obtain professional assistance, and do not feel they have been sufficiently prepared for such responsibilities (Hails & Borum, 2003). Law enforcement leaders are recognizing the need to respond more effectively to mental health crises (Borum, 2000; Thompson & Borum, 2006). Law enforcement officers and their leaders increasingly have to confront territory that can be challenging for professionals not trained in the medical and mental health systems (Borum, 2000; Borum, Deane, Steadman, & Morrissey, 1998: Thompson & Borum, 2006). Leaders and administrators in the law enforcement profession have discovered that civil liability and community relations issues can arise from failed attempts to achieve positive outcomes in

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dealing with crises that are precipitated by a mental health issue (Borum, 2000; Thompson & Borum, 2006). Mental Illness and the Criminal Justice System One factor contributing to the mental health crisis is the growing number of persons with mental illness who are no longer being treated in state institutions or hospitals (Borum, 2000: Lamb, Weinberger, & DeCuir, 2002; Markowitz, 2006; Siegel, 2003; Thompson & Borum, 2006). This ―de-institutionalization‖ of the mental health system has put many individuals into communities around the country for community treatment options. De-institutionalization does not suggest that hospitalization no longer occurs, or that longer-term treatment options do not exist; however, there are fewer treated in these institutions. For example, from 1970 to 2002, nationally, there was a decrease in state psychiatric hospital and Veteran’s Administration psychiatric hospital beds of nearly 400,000 beds (Foley et al., 2006). The first psychiatric hospitals, established in the 1800s, received criticism throughout their history for the quality of care they provided mentally ill patients. The hospitals seemed to lack treatment resources, and were more often viewed as custodial institutions rather than treatment institutions. By the mid 1900s, new psychiatric treatment options and pharmaceutical products were emerging, and the community mental health movement was beginning. In 1963, President John F. Kennedy signed the Community Mental Health Centers Act into law. The bill intended to provide $3 billion to fund the transition of persons with mental illness to community based treatment; however, after President Kennedy’s assassination, none of the allocated money was spent

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for this purpose. In addition to legislative efforts toward community mental health, federal lawsuits, and exposure of hospital conditions fueled the deinstitutionalization of the mental health system. These changes ultimately had an impact on the Florida mental health system and resulted in the closure of many of the state hospital options (Florida Supreme Court, 2007). Florida hospitals have decreased the number of hospital beds in community psychiatric facilities. In 1994, there were 6,467 beds, and by 2006, that number decreased to 4,021 beds. Additionally, the state psychiatric hospitals have seen in a decrease in beds from 1,926 in 1997 to 921 in 2007 (Florida Department of Children and Families, 2007; Florida Supreme Court, 2007). Deinstitutionalization and public funding issues have affected the criminal justice system (FSC, 2007; Thompson & Borum, 2006). Law enforcement officers are in a position where they are frequently becoming the frontline mental health crisis interventionists. Officers regularly encounter persons with mental illness, and these interactions can result in decision-making options that include criminal justice involvement (Borum, 2000: Lamb et al., 2002: Munetz & Griffin, 2006; Siegel, 2003; Teller et al., 2006; Thompson & Borum, 2006). In fact, some estimates show that law enforcement officers encounter persons with mental illness in as much as 7% to 10% of their contacts with the public (Deane et al., 1999; Janik, 1992; Munetz & Griffin, 2006 ). Police officers become gatekeepers when it comes to decision-making about placement in the mental health or criminal justice systems at a time of mental health crisis (Lamb et al., 2002). In other words, lack of funding and resources in the mental health treatment

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system are shifting the responsibility of caring for those who have a mental illness to the criminal justice system. National Attention to the Issue Professional organizations and the federal legislative branch are addressing the need for law enforcement officers to utilize special care when interacting with people who have a mental illness. The president of the International Association of Chiefs of Police (IACP) indicated that police chiefs and law enforcement executives are ready to give attention to the special needs of those experiencing a mental health crisis. His address to association members in The Police Chief magazine emphasized the importance of recognizing the need for special care and training when encountering a person with a mental health condition (as cited in Ruecker, 2007). According to the president of IACP: Other areas need careful and thoughtful examination. Over the last two decades, we have seen a dramatic change in the type of housing and care for the mentally ill in our communities. People who used to be institutionalized are now living in mainstream society. All too frequently, their encounters with police have resulted in tragedy. We can improve on the degree to which we prepare our officers to deal with the mentally ill. Like user-of-force issues, this is not an issue solely for police; we need whole communities to work together on it. Again, we will work with the mental health community and our criminal justice partners to help develop recommendations for more effective training, policies, available resources, and response to our encounters with the mentally ill. (Ruecker, 2007, p. 6)

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Law enforcement professional organizations and leaders, such as the president of IACP, can be influential within the police culture. Opinions of respected officials and entities within the profession can further perceptual changes within the professional culture. These changes can encourage members within the profession to consider new ideas and concepts to address issues affecting the community and the profession. The legislative branch of the U.S. government addressed the concerns of persons with a mental illness and their involvement with the criminal justice system by appropriating funds to address issues related to treatment and diversion from the criminal justice system. Originally enacted in 2004, the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTRCRA) was designed to help states and counties in the U.S. collaboratively address criminal justice and mental health issues by providing funding and opportunity for the two systems to work together to address critical issues that impact persons with mental illnesses. In 2007, the Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act (MIOTRCRRIA) was introduced to continue the efforts started under MIOTRCRA through 2013. This act authorizes 50 to 75 million dollars per year to continue diversion and treatment of those who have a mental illness from the criminal justice system (Consensus Project, 2008). Florida and Pinellas County Specific Mental Health System and Issues For better understanding of this study, it is helpful to have background relevant to the community in which the study was conducted. Pinellas County is located within the

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State of Florida. This section will provide information on Florida and Pinellas County specific issues related to this study. According to the American Association of Suicidology (2006), in 2004, Florida had the second highest number of suicides in the U.S. with 2,389 reported cases. The National Institute of Mental Health (2006) indicated there are approximately one million people experiencing a serious mental illness in Florida. Recent statistics indicate that in a 3-year time span, from July 2004 through June 2007, 41,997 adults in Florida had two or more involuntary commitments under the state’s involuntary mental health commitment law (Petrila & Christy, 2008). There is information indicating that Florida’s jails have become some of the largest psychiatric treatment facilities in the state. An estimated 125,000 adults with diagnosed mental illnesses are booked into Florida’s local jails every year (Florida Supreme Court, 2007). According to the FSC report, ―there are approximately 16,000 prison inmates, 15,000 local jail inmates, and 40,000 individuals under correctional supervision in the community who experience serious mental illness‖ (p. 10). The FSC report also estimates that approximately 70% of the 150,000 juveniles referred to Florida’s Department of Juvenile Justice have a mental health disorder. From 1999 through 2006, statistics indicated a 72% increase in forensic commitments, or persons ordered through the criminal justice system into treatment due to a mental illness (FSC, 2007). Forensic commitments include criminal court dispositions such as finding that a person is incompetent to proceed in a trial, or is not guilty by reason of insanity. These numbers underscore the seriousness of the issues

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surrounding psychiatric and criminal justice involvement with persons who have a mental illness, and illustrate the impact on the criminal justice system by our current system of care for those who have a mental illness. In fact, the FSC (2007) report calls the Florida jails and prisons ―psychiatric warehouses‖ due to the lack of funding and lack of comprehensive community treatment programs (p. 10). An explicit recommendation by the FSC report is to further intervention programs such as the CIT concept. Florida utilizes the ―Baker Act‖ as the means of providing voluntary and involuntary treatment for persons with mental illnesses requiring hospitalization. This procedure is based on a 1971 Florida law titled the Florida Mental Health Act (FMHA), and referred to as the Baker Act. The act was named after the legislator that sponsored FMHA (Florida Statutes, 2007; State of Florida, 2007). The Florida Department of Children and Families (DCF) has regulatory responsibilities related to this Act (DCF, 2006; Florida Statutes, 2007). Since 1971, there have been modifications to the Baker Act; however, it still provides the framework for legal and procedural issues surrounding psychiatric hospitalization for persons hospitalized voluntarily or involuntarily. This act allows law enforcement officers, licensed mental health professionals, physicians, and judges to initiate involuntary examinations. In order to initiate an involuntary examination of a person, a comprehensive set of conditions must be present, as required by law. Criteria for the Baker Act require the person initiating the Baker Act to believe a person has a mental illness, cannot consent to treatment, and is believed to present a danger to themselves or others (Florida Statutes, 2007).

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According to the Pinellas County (2007) website, the population of Pinellas County, FL in 2000 was 921,495 people; in 2005, the population was 944,773. The Florida Mental Health Institute (FMHI) at the University of South Florida keeps statistics on Baker Act’s for the State of Florida. To provide an idea on how often there are hospitalizations in Pinellas County, FL under the Baker Act, FMHI (2007) statistics indicated that in the year 2000, 5,779 Baker Act admissions took place. They report that as of 2005, there were 8,380 admissions (FMHI, 2007). When looking specifically at adults taken into custody under the Baker Act, a large number of individuals account for Baker Act admissions. For example, in 2002, of the 6,464 Baker Act admissions, there were 4,831 individual adults who accounted for these hospital admissions (Christy, 2007). These numbers are consistent for 2003 through 2005 (Christy, 2007). According to the Florida Suicide Prevention Coalition (2007), Pinellas ranked second in Florida counties for the highest suicide rates. The FSPC reported that in 2001 there were 167 suicides in Pinellas County, and it 2005 there were 154 suicides in Pinellas County. Florida CIT Coalition In 2004, representatives from thirteen of the 67 counties in Florida met in the Orlando area to begin sharing information and collaborating on CIT efforts. Another purpose of this meeting was to begin a process of determining the format and content of CIT programs in Florida. One issue was whether Florida counties were going to encourage fidelity to the Memphis Model of CIT. Out of the first meeting in Florida came the creation of the Florida CIT Coalition that began meeting quarterly to continue their

Full document contains 141 pages
Abstract: In the United States, law enforcement officers frequently manage encounters with people who are experiencing mental health crises. The crisis intervention team (CIT) training prepares officers for handing situations that involve people with mental illnesses, and communities are adopting CIT programs. Proponents of CIT training theorize that it improves outcomes for those in mental health crises, such as diversion from jail, improved safety, and increased mental health referral. The sequential intercept, which provides the theoretical foundation for this study, identifies five opportunities when people with mental illnesses can be diverted from the criminal justice system. The model's first intercept point is law enforcement discretion in potential arrest situations. However, there is a scarcity of empirical research addressing the impact of CIT training on arrest outcomes The purpose of this quasi-experimental study was to examine whether CIT trained officers differ from officers who are not CIT trained on use of force, number of injuries to officer, number of injuries to those in crisis, and the disposition of these service calls. Archival data from one sheriff's office were utilized for this analysis; data included 450 deputy sheriffs and encompassed 4,453 incidents. Data were analyzed using MANOVA, ANOVA, Kruskal-Wallis, and Kendall's Tau b. Small but statistically significant differences were found between CIT and those not CIT trained deputies. CIT trained officers were associated with lower rates of injury to citizens in mental health calls and were more likely to provide mental health referrals. This research contributes to social change by documenting the need for specialized law enforcement training and the positive impact it may have on people with mental illnesses.