Problematic Behavior or Activity
In 2011, local law enforcement in Deschutes County responded to more than 1,000 calls involving allegedly mentally ill subjects or police officer holds (when a police officer takes an individual to a facility, such as a hospital). In addition, the departments collectively responded to more than 500 reports flagged as mental health–related, with 71 percent of those people flagged as suicidal. The Bend Police Department responded to 891 mental health calls in 2012. Deschutes County Jail (DCJ) personnel estimate that approximately 25-30 percent of inmates are currently prescribed psychotropic medications. In 2012 the DCJ reported 66 emergency room visits for inmates requiring medical or behavioral health treatment or evaluation from ER staff; 46 inmates placed on behavioral health observation (threat of harm to self); and 119 calls for mental health for evaluations.
Impact on the Community
Each arrest and incarceration requires considerable resources of local law enforcement. Officers often arrest someone with mental illness because there is no available mental health service or the person fails to respond appropriately to their request. Officers experience long wait times in the emergency department, which pulls patrol officers off of the streets and makes them unavailable to respond to other calls. The increased number of arrests stresses the county jail facility. In 2012 the Deschutes County Sheriff’s Office established a contract with nearby Jefferson County to rent additional beds because of overcrowding issues in the main facility and the inability to properly transfer inmates to the work center. Locally, offenders with mental health problems suffer recidivism rates greater than 70 percent, meaning two out of three will re-offend within a 3-year period. Additionally, communication between the police department and mental health agencies was strained, as neither agency had a good understanding of what the other one did or what the other’s roles were.
In the spring of 2010, community stakeholders in Deschutes County established a steering committee to identify relevant issues and work collaboratively to deliver improved services to those dealing with mental illness. Steering committee members included employees from St. Charles Medical Center; Deschutes County Behavioral Health; the Bend Police Department; Deschutes County Adult Parole and Probation; the Redmond Police Department; and the Deschutes County Sheriff’s Office. By winter of 2011, the committee had firmly established the Deschutes County Crisis Intervention Team (CIT) and developed a 40-hour CIT training program for county law enforcement based on the Memphis CIT model.
The “Memphis Model” is an innovative police-based first responder program of pre-arrest jail diversion for those in a mental health crisis. This program provides law enforcement–based crisis intervention training for helping people with mental illness. CIT works in partnership with those in mental health care to provide a system of services that is friendly to the individuals with mental illness, family members, and the police officers. A CIT helps officers understand how to best navigate a perpetrator’s specific issues and how to guide that person not into prison but toward a hospital or proper medication. This approach is safer for officers entering potentially volatile confrontations, encourages longer-term solutions for perpetrators, and reduces crime rates in the process.
The work of the Deschutes County CIT Steering Committee was not done once the CIT training program was launched. In 2012, the CIT steering committee received a grant from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) GAINS Center for Behavioral Health and Justice Transformation to conduct a Sequential Intercept Mapping (SIM) workshop, which was facilitated by Policy Research Associates, Inc. That workshop helped the community better understand its criminal justice system and identify the county’s limitations and gaps with regard to diverting people with mental illness from the criminal justice system and service delivery. That workshop led to the steering committee applying for and receiving federal grant funds to hire a full-time CIT coordinator to further meet the department’s training needs and better organize the efforts between law enforcement agencies and behavioral health treatment providers.
The CIT coordinator acts as a liaison among law enforcement, legal agencies, and mental health agencies, to provide support and address problems in order to reduce the impact of allegedly mentally ill individuals on these systems. Deschutes County has substantial support from local agencies and community members to enact positive change as it relates to providing services to people with mental illness. Unfortunately, all agencies have the challenge of balancing the need for services and the ability to provide them within current budgets. Adding a CIT coordinator to synchronize support and linkage of services within Deschutes County was vital to the program.
A full-time CIT coordinator was hired and began working at the Bend Police Department at the end of 2013. The grant-funded position will end on March 31, 2016, but the CIT Steering Committee and the City of Bend Police Department are committed to continuing the training on an annual basis for local and regional law enforcement officers.
Based on Research
The “Memphis Model” of CIT training includes 40 hours of oral and visual presentations, scenario-based training, and interactions with the local affiliate of the National Alliance on Mental Illness. For more information on this training model, see CIT International Memphis Model.
See also Core Elements.
The City of Bend Police Department received federal grant funding from the U.S. Department of Justice, Bureau of Justice Assistance, to support the CIT coordinator role for 30 months. Community agencies contributed to the training by providing trainers, role players, snacks at the trainings, and supervision.
As of March 2016, the steering committee’s goal of training 30 percent of regional police officers in CIT was met and exceeded, as follows:
- Deschutes County Sheriff’s: 30% trained
- Bend Police Department: 90% trained
- Redmond Police Department: 50% trained
- Sunriver Police Department: 50% trained
- Black Butte Police Department: 50% trained
- Crook County: 43% trained
The training of officers has resulted in a documented decrease in use-of-force incidents involving allegedly mentally ill people during dispatched or officer-initiated contacts. Redmond Police Department documented a 55 percent decrease in physical control, a 60 percent decrease in Taser deployments, and a 35 percent decrease in firearm display. Bend Police Department reported a 34 percent drop in overall use of force. Both the Redmond and Bend Police Departments have CIT-trained officers available 24/7.
The use of police officer holds has dropped. The CIT curriculum includes resources for diversion from jail and hospitals when dealing with a person experiencing symptoms of a mental health disorder. The use of walk-in clinics vs. hospital emergency room visits has also increased since the CIT training began. The focus has shifted from enforcement to a therapeutic response.
The program has allowed the development of boundary spanners; Law enforcement has been able to coordinate with mental health agencies such as St. Charles Mental Health and Deschutes County Behavioral Health for treatment options in the best interest of the individual and family. An expanded list of resources has reduced repeated contact among subjects and the police departments. This training has helped to build positive working relationships among agencies, building trust and respect.
Building on the CIT training, the City of Bend Police Department has also created a Community Response Team of three officers who have received not only CIT training, but additional training about mental health systems and verbal de-escalation skills to respond to active mental health crisis calls. When the team is not responding to active calls, the officers do follow-up with and provide resources to prior contacts and their family members.
Critical Success Factors
Our community has long recognized a need for the training and a strong desire to work together to help save the lives of those involved in these types of crisis situations. Our County Commissioners and City Council Members are very supportive of the CIT program and allowed departments under their supervision (Deschutes Sheriff’s Office and Bend Police Department, respectively) to authorize staff to set aside time to work on a solution. The Deschutes County Attorney supports our local training and presents on liability and laws around mental health issues at the training.
Team building among agencies, education on what each agency can do, and understanding that the end goal—better services and outcomes for people suffering from mental illness—is the same for all agency members have greatly increased trust and created good working relationships among community partners. Attending conferences as a team has been very beneficial.