FAQ

Essential Elements Background

Introduction

About the Elements

Methodology

Disclaimer

1. Introduction

The nation's prisons and jails hold unprecedented numbers of people with mental illnesses—many of whom exhibited behaviors related to their illness that factored significantly in their arrest.[1] Individuals with mental illnesses who are drawn into the criminal justice system usually make initial contact through the officer on the street.[2] These front-line officers frequently need to make difficult decisions about whether to resolve incidents involving people with mental illnesses informally or to take them into custody. Those decisions can have a significant impact on the person with a mental illness, family members, and on the resources that will need to be committed by courts, corrections, and other disciplines within the criminal justice system. And although these incidents are generally resolved safely, on rare but highly publicized occasions they can result in the officer, the person with a mental illness, or bystanders being seriously injured or killed.

In response, specialized law enforcement-based programs began appearing in the late 1980s with the emergence of the crisis intervention team (CIT) and police-mental health co-response models.[3] These initiatives were designed to improve outcomes for these encounters and to provide a compassionate response prioritizing treatment over incarceration when appropriate; they have been characterized by on-scene crisis de-escalation tactics, a wider range of disposition options for people with mental illnesses, and strong partnerships with community stakeholders.[4] Since that time, hundreds of communities have implemented such programs by adapting the CIT or co-response models to their jurisdiction's unique needs. [5] And though this number represents only a small fraction of U.S. communities, there are many indicators that the level of interest in specially crafted criminal justice-mental health initiatives is surging.[6]

As the growing number of interested communities grapple with implementing police-based response programs, there is a commensurate demand for more information on the components, or elements, that comprise promising programs, and how these components can be successfully implemented at the local level. Several communities have tried to identify critical program elements, particularly for CIT initiatives, to promote consistency and quality. However, there has been limited debate or agreement at the national level about which elements are essential to all specialized police-based response programs.

This document is meant to advance the discussion on how communities can improve the overall criminal justice response to people with mental illnesses at the point of first contact—encounters with law enforcement. The text articulates ten essential elements for any specialized police-based response. They are derived from recommendations made by a broad range of practitioners and other subject matter experts. These elements provide a common framework for effective implementation that will promote positive outcomes, while being sensitive to the distinctive needs and resources of each jurisdiction. Individuals who are interested in initiating or improving a police-based response—whether or not they have a formal program—will be able to review the essential elements described below to help direct their efforts.

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2. About the Elements

The ten essential elements describe recommended approaches to specialized police-based program design and implementation. Each element contains a short statement describing criteria that specialized police-based response programs should meet, followed by several paragraphs explaining the element's importance and how it can be achieved.

The Essential Elements document is one in a series of resources available through the U.S. Department of Justice's Bureau of Justice Assistance (BJA) Law Enforcement/Mental Health Partnership Program. The Partnership Program provides tools and resources for communities to improve police responses to people with mental illnesses. It is coordinated by the Council of State Governments' (CSG) Criminal Justice/Mental Health Consensus Project with guidance from the Police Executive Research Forum (PERF).

The document reflects several key assumptions: First, at the heart of each element is the importance of meaningful collaboration among professionals in the criminal justice and mental health systems. There is consensus that successful partnerships are needed to carry out any of the elements, yet achieving the requisite level of collaboration is difficult—particularly when there are long-standing system barriers. Second, the elements recognize that police represent only the first point along a complex continuum of criminal justice systems. Addressing problems raised by the high numbers of people with mental illnesses in the system requires a comprehensive community- and system-wide strategy in which the police-based program plays only one part. The impact of a planned police-based program on jails, courts, the community-based mental health system, and the larger community must be considered in planning and implementing the program.

The elements are drawn primarily from the experiences of law enforcement, mental health professionals, advocates, and consumers. They are meant to help guide communities interested in developing a police-based program or improving the organization and functions of an existing program. Some studies are underway, and more are being planned, to provide a stronger evidence base for how these programs can best operate, their impact, and the relative importance of the various elements that comprise them. As specialized police-based response programs mature and this new research become available, clarification and greater specificity to these elements are expected. This document is meant to be a "living, breathing document" that will be periodically updated.[7]

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3. Methodology

The essential elements are drawn from a variety of sources, including interviews with practitioners and community members who have been engaged in these programs for many years, as well as a review of the scholarly literature. A panel of national experts also guided early drafts of this document.[8]

This is the first publicly disseminated draft of the Essential Elements document. It is being posted on a Web-based discussion forum so that practitioners in the field and other stakeholders can further enhance its content. An advisory group of leading executives, practitioners, researchers, and other experts will then review and discuss these comments and suggest revisions before it is disseminated for use.

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4. Disclaimer

This document was prepared by the Council of State Governments' Criminal Justice/Mental Health Consensus Project, under cooperative agreement #2005 MU XK208 awarded by the Bureau of Justice Assistance (BJA), Office of Justice Programs, U.S. Department of Justice. The opinions and findings in this document do not necessarily represent the official position or policies of the U.S. Department of Justice. While every effort was made to reach consensus and represent advisory group members' and other reviewers' recommendations, individual opinions may differ from the statements made in the document. This document follows the format and scope of the 2005 Essential Elements of a Mental Health Court, another CSG product with support from BJA (found at consensusproject.org/mhcourts_archive/essential.elements). A similar document describing the elements of programs that bring together the corrections and mental health systems is currently in production.

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[1] For example, the Los Angeles County Jail, the Cook County Jail (Chicago) and Riker's Island (New York City) each hold more people with mental illnesses on any given day than any hospital in the United States. And while approximately 5 percent of the U.S. population has a serious mental illness, the U.S. Department of Justice reports that about 16 percent of the population in prison or jail has a mental illness. E. Fuller Torrey. "Reinventing Mental Health Care," City Journal 9:4 (1999); R. C. Kessler et al., "A Methodology for Estimating the 12-Month Prevalence of Serious Mental Illness," in R.W. Manderscheid and M.J. Henderson (eds.), Mental Health United States 1999. (Rockville, MD: Center for Mental Health Services, 1999); Paula.M. Ditton, Mental Health Treatment of Inmates and Probationers, U.S. Department of Justice, Bureau of Justice Statistics (Washington, DC: 1999), NCJ 174463.

[2] For the purposes of this document, "officer" and "police" refer to any law enforcement personnel with direct contact with the community; this includes sheriffs' deputies, state troopers and others with arrest powers.

[3] The CIT model, originated by the Memphis (TN) Police Department (and often called the "Memphis Model"), positions highly trained officers to respond to the majority of incidents involving people with mental illnesses. The police-mental health co-response model, first implemented by the San Diego (CA) Police Department, pairs specially trained officers with mental health professionals to respond to these types of incidents.

[4] Throughout this document, the term "stakeholders" is used to describe the diverse group of individuals affected by police encounters with people with mental illnesses, such as criminal justice and mental health professionals; myriad other service providers, including substance abuse treatment, faith-based groups, and housing professionals; people with mental illnesses; their loved ones; crime victims; and other community representatives.

[5] Many communities have also developed teams of community mental health professionals, such as mobile crisis or assertive community treatment teams, to assist officers at the scene. While these models are undoubtedly a valuable resource for many communities and departments, they are not police-based and are therefore not the subject of this document.

[6] Federal interest in criminal justice-mental health initiatives is perhaps best illustrated by the broad bipartisan support for the Mentally Ill Offender Treatment and Crime Reduction Act of 2004 (MIOTCRA); and the fiscal year 2006 appropriations for the grant program (fiscal year 2007 appropriations are being considered as this goes to press). MIOTCRA facilitates collaboration among the criminal justice, juvenile justice, mental health treatment, and substance abuse systems in diverting individuals to treatment when appropriate. Among its uses, MIOTCRA funds can support law enforcement training. Interest in law enforcement-mental health initiatives, in particular, is reflected in the increasing demand for national conferences on how to implement these collaborative efforts.

[7] Updates to this document can be found at www.consensusproject.org/projects/law-enforcement/elements.

[8] CSG thanks the many contributors to this project. This document could not have been written without the leadership of BJA, particularly A. Elizabeth Griffith, Associate Deputy Director for Policy; Robert Hendricks, Acting Senior Policy Advisor for Mental Health; and Michael Guerriere, former Senior Policy Advisor for Mental Health and Substance Abuse. CSG also owes its gratitude to Melissa Reuland, who co-authored this document; Ms. Reuland is a Senior Research Consultant with PERF, A complete list of advisors can be found on the Contributors page.