Individuals with mental health and/or substance use disorders often require assistance across government services, making it essential that these services work together. Counties play a vital role in providing those services to the 1 in 5 adults in the United States with a mental health or substance use disorder. According to NACo (the National Association of Counties), counties invest approximately $100 billion in community health systems annually, including behavioral health services.
Approximately 750 behavioral health authorities and community providers across the nation operate community-based services for individuals suffering from mental health and substance use conditions. A robust continuum of care for these individuals can link them to appropriate medical services and divert them from possible contact with the criminal justice system.
NACo has developed a brief outlining elements of a behavioral health care continuum along with strategies counties can use to build a countywide crisis intervention team. The brief suggests the establishment of practices and programs that help people:
- Before an emergency, through connections to community treatment and services for unmet behavioral health needs before they escalate to a crisis,
- During an emergency, through a coordinated crisis response system that provides someone to call, someone to respond, and somewhere to go, and
- After an emergency, through continuing linkage to appropriate services, peer support, and recovery care.
For this article, we will focus on the continuum element involving the “someone to respond” during an emergency and discuss how to build a countywide crisis intervention team effectively. We will begin by answering the question: “What exactly is a crisis intervention team?”
Officially, the CIT model was established in 1988 through a seed grant from NAMI (National Alliance on Mental Illness) to build what is known as the “Memphis” model. In 1987, a young black man threatened people with a knife in Memphis, and police officers were called to respond.
The man, who had a history of mental illness, refused to put down the knife and was shot and killed by police. The event sparked numerous protests declaring racism and police brutality. Fortunately, the community came together to develop a better way to intervene during a mental health crisis, and the CIT model was born.
NAMI describes the CIT program as “local initiatives designed to improve the way law enforcement and the community respond to people experiencing mental health crises. They are built on strong partnerships between law enforcement, mental health provider agencies, and individuals and families affected by mental illness.”
To assist communities in building a countywide crisis intervention team, the University of Memphis has created a resource that covers laying the foundation of your program, developing and implementing a plan, and sustaining and expanding the program. We will examine each of these areas in this article.
Laying the Foundation for a Crisis Intervention Team
Laying the foundation for your CIT program will include researching the model and opening conversations with possible partners in your community. Typically, CIT programs partner with advocates, universities, hospitals, peers, family members, and social service providers.
Once you’ve identified partners, schedule a meeting to start the process and assess your community’s unique needs. The discussion should focus on understanding each partner’s perspective on the crisis response system.
This open dialogue with key stakeholders helps uncover common interests and concerns. It’s also essential that your program partners include people with lived experience and family members of people living with mental illness.
Since CIT’s founding more than 30 years ago, family advocates have been a driving force behind CIT’s national expansion. In addition, people living with mental illness, or peer advocates, are a vital component because they can explain symptoms and discuss personal interactions with law enforcement and mental health providers. Both groups provide critical education to partners about the kinds of support that promote recovery and can help to destigmatize mental illness.
An essential first step in laying the team’s foundation is the creation of a Steering Committee. The committee should initially include the core partners – law enforcement, mental health providers, and advocates. You might also have other community leaders, such as judges or county commissioners, who can become champions for CIT. The committee should unite to assess strengths and weaknesses in the crisis response system and begin setting their intentions and commitment to CIT.
Developing and Implementing Your CIT Plan
The University of Memphis’ guidelines suggest that a delegation of your committee members visit another program to understand better the commitment required for partners. Subcommittees can then be developed to focus on these three issues: mental health/criminal justice system coordination, data on law enforcement response to crisis calls, and training.
Each subcommittee should include a representative from the three key partners. Working together will create opportunities to build trust and feel a sense of ownership over the program. At the heart of every successful crisis intervention team is a CIT Coordinator.
The coordinator facilitates partner relationships and manages the day-to-day aspects of the program. Their most important role is building trust and improving communication among the partners – they need to be able to recognize all the partners’ strengths and weaknesses. Thomas von Hemert, CIT Coordinator of the Thomas Jefferson Area CIT Program in Charlottesville, Virginia, put it this way: “The focus [of the coordinator] is developing trust, relationships, and contacts among your mental health, law enforcement, and medical personnel. Do you have the cell number of all your task force members in your phone? If so, you’re doing it right.”
Implementation of your plan happens when the Steering Committee puts the pieces of the model together and adapts them to your community. During this process, partners should develop a memorandum, create policies and procedures, recruit trainers, and select and train police officers.
CIT officers are the face of CIT, so it is vital to choose officers carefully for participation in the program. A strong character and temperament are essential to helping people in crisis. Program leaders have found that asking for volunteers from law enforcement is more effective than assigning officers.
The training of dispatchers is also vital to the success of your crisis intervention team. The training should include mental health topics and basic verbal de-escalation skills. Often, dispatchers attend the full 40 hours of CIT training alongside law enforcement.
Choosing an Effective Technology Platform to Build a Crisis Intervention Team
Information technology can vastly improve the delivery of services across the crisis care continuum. However, choosing an effective technology platform for your program requires a solution that promotes using shared databases across all agency partners while protecting patient rights.
Julota’s robust community information platform is the ideal solution for your crisis intervention team program. Its interoperable platform allows you to track data and patient encounters across systems safely and securely.
Its HIPAA-compliant solution means that patient data is secure across service organizations in your program. Your team will have real-time access to any needed data via their own devices such as smartphones, laptops, or computers. Data integration will provide more quality outcomes and improve officer safety and effectiveness in their response to individuals experiencing a mental health crisis.
Sustaining and Expanding Your Crisis Intervention Team
It is important to remember that your countywide crisis intervention team program is an ongoing program that will require continued commitment from the Steering Committee and all agency partners. It will only be successful if it is envisioned as a process of transformation of the community’s response to people experiencing mental health crises.
As the community’s needs change, the program’s integrity will require a diligent effort to work with and identify those changes. Data collection to document your program’s activities will be vital to understanding whether the program is being implemented as planned.
Julota’s powerful TouchPhrase Interface will provide dynamic data collection and analysis to help identify gaps or problems. Additionally, this data can help indicate where program improvements need to be made. Good information is also vital to accurately calculate the costs of the existing program and estimate costs for expanding the program.
Sustaining and expanding your program will also mean developing partnerships, networking with the community, and raising awareness. As your program matures, front-line workers connected with the program are uniquely positioned to identify where additional services are needed.
These might include criminal justice leaders, mental health courts, or other social services organizations. Frequently, communities expand efforts to address specific populations such as children or veterans.
Raising public awareness is another important aspect of sustaining and expanding your program. If individuals with mental illness and their families are unaware of the program, they won’t know whom to call for help. Community awareness makes it easier for them to access CIT officers and helps partner agencies remain committed to the program.
An effective countywide crisis intervention team can help transform your community’s mental health response. It is not just a law enforcement program to determine how they respond to mental health crisis situations. What is the most effective way to build a countrywide crisis intervention team? It is a partnership with mental health professionals, advocates, peers, and family members. A successful program includes trust, mutual respect, and shared goals.