Recommendations for Implementation

In every jurisdiction, a lead training official or a training development committee is likely to identify law enforcement personnel who interact regularly with people with mental illness but have received little or no meaningful training on this subject. These staff, who have already met their recruit training requirements but are not prepared to take refresher courses during in-service training sessions, need new skills training.[2] Recipients of this training should include call takers and dispatchers, front desk personnel, new hires, and patrol officers, as well as some detectives, drug-enforcement officers or others.  Depending on the size and needs of a particular jurisdiction, it may be necessary to train additional personnel not covered in these categories, such as communications officers, or other civilian personnel.

New skills training should occur at the outset of any new departmental initiative regarding mental illness. The first goal of this training is to teach department personnel and affiliated staff to recognize signs of mental illness so they can respond accordingly.  The purpose of this training is not to enable these line staff to be diagnosticians; rather, officers and staff should emerge from this training capable of identifying observable behaviors that might point to the existence of mental illness.  Furthermore, officers should be encouraged to consider how a potential mental illness may have contributed to an incident.

The second goal of this training is to teach officers and staff to stabilize and de-escalate the situation, while conveying an attitude of respect for people with mental illness and their families.  They must understand relevant statutes and how to respond to not escalate the problem while a response is developed.  By helping personnel to understand how they may inadvertently use language or take actions that stigmatize mental illness, trainers can also teach police personnel to change actions that may previously have been viewed as disrespectful.  To this end, the direct involvement of consumers and family members in this new skills training will help to emphasize destigmatization as a training goal as well as the partnership between mental health personnel, advocates, and law enforcement personnel.  The importance of partnerships can develop from the start of an officer's career.  (See Policy Statement 33: Identifying Trainers, for more on incorporating consumers and family members into training initiatives.)

Third, this orientation to mental health issues for personnel should teach them the importance of getting the right assistance and referrals for those with mental illness and victims of crime.  Understanding local resources, their criteria for gaining access, and other sources of assistance will be of tremendous benefit to personnel.

Recruit training refers to the fundamentals taught to each new law enforcement officer ("recruits").  Regardless of educational level attained, all new recruits are required to train in the academy before beginning service at a law enforcement agency.  (The duration of academy training for lateral transfers will vary by state.)  Academy-level training should incorporate at least eight hours (and as many as fifteen) of training on general mental health issues.  These may be integrated into existing training modules.State mandates for training and existing curricula differ across jurisdictions. Agencies will need to tailor training models to their unique needs and requirements. [3]  (See chart for suggested training topics.)

Given the complex nature of many situations encountered by law enforcement officers, recruit training should touch on signs and symptoms of mental illness, dual diagnosis of mental illness and drug/alcohol abuse, and related issues. Again, although recruits cannot and should not be trained as diagnosticians, they must be trained to respond to a range of aberrant behavior, regardless of whether it can be attributed to mental illness, a medical disorder such as epilepsy, drug abuse, or a combination of these factors.  (See Policy Statement 4: On-Scene Response, for a more thorough discussion of people with co-occurring disorders, especially as they relate to law enforcement; also Policy Statement 37: Co-occurring Disorders.)

After finishing academy training, recruits (now considered "new hires") are assigned to work with more senior Field Training Officers (FTOs) before beginning independent duty.  Like all new employees, new officers are extremely impressionable.  FTOs are responsible for introducing the new officers to agency culture and priorities.  Additionally, the FTO may contribute to the new officer's patterns of behavior.  For these reasons, it is important that among the issues FTOs review, they understand the recruit mental health training to be able to reinforce topics covered at the academy.

To complement pre-service training for recruits, law enforcement agencies should make an effort to acquaint new hires with community members who have mental illness and family members of people with mental illness.  Familiarity with consumers is of particular importance, as many new officers may have had little to no contact with this population.  Officers should be encouraged to visit consumer clubhouses and peer support projects, offer to sit on ACT program boards of directors, speak at local mental health group meetings, and participate (when invited) in social events where consumers are regularly present.  Interactions with people who have mental illness who are not in crisis can put a "human face" on mental illness that will challenge myths or misconceptions officers may have.

Example:  Long Beach (CA) Police Department

The Long Beach Police Department requires that all new recruits attend "Field Contacts with People with Mental Illness." Through this course, recruits are introduced to consumers both in the classroom and in mental health facilities.

Example:  Montgomery County (MD) Police Department

The Montgomery County Police Department holds part of its training in the physical space of a public mental health facility to familiarize officers with people with mental illnesses.

Through such training exercises, officers see that people with mental illness do not always exhibit signs of their condition.  The officers also come to understand the effects of unintentionally stigmatizing people with mental illness, and the impact that an inappropriate response in a situation involving mental illness can have on a person, a family member, the victim, or the community.

As discussed at the outset of this policy statement, in-service training refers to periodic courses provided to all officers at some interval (e.g., annually, biannually) to expand on previous training or as a refresher.  Though some of these topics may be addressed in new skills or recruit training, in-service training is an important opportunity to reinforce the department's sensitivity to people with mental illness and to update staff about changes to the department's response protocols.  At least twenty hours of in-service training should be provided over a three-year cycle. In some cases, it may be inappropriate to wait until such training sessions; in such an event, the updates can be provided during informational roll calls, integrated into related modules such as those on use of force, cultural diversity, or special populations.  Stand-alone modules are preferable, but recognizing the many mandate training topics, an integrated model that uses some stand-alone modules may be necessary. Issues such as the difference between mental illness and disorders such as epilepsy or autism, cultural and gender differences among individuals with mental illness, and medication issues may all be suitable topics for in-service training   (see chart for more suggested topics.)

Example:  Seattle (WA) Police Department

The Seattle Police Department requires all officers to attend a mandatory eight-hour block of instruction to develop an adequate competency level when encountering citizens with mental illnesses.

Trainers should consider including nontraditional exercises such as having police officers attempt tasks associated with daily living while being exposed to "voices." Training should also include opportunities to meet with consumers and their families in the field, at clubhouses, shelters, soup kitchens, and NAMI support parties and meetings, just as is recommended for recruits.  In addition, training should provide the chance for law enforcement officers to visit crisis centers and mental health facilities in order to gain resource awareness. Officers should be given ample opportunity topractice de-escalation techniques, such as talking to the person with mental illness and waiting out a violent episode, as well asto run through diversion protocols that rely oncontacting community-basedmental health services and supports. (See Policy Statement 3: On-Scene Assessment, for more on de-escalation techniques.) Role-playing exercises are one way to help officers model these behaviors prior to using them in the field.  As a caution, the training facilitator should carefully monitor role-playing exercises. When left unchecked, officers can disengage and not fully participate in role-play exercises or, at the other extreme, participants can be become overinvolved to the detriment of the class and ultimately to the detriment of people with mental illness.

Example:  Montgomery County (MD) Police Department

The Montgomery County Police Department employs an exercise in which officers are required to wear headphones that blare loud music and voices, conveying disconnected thinking. Officers are asked to go about their routine tasks while wearing the headphones. The purpose of the activity is to simulate some of the challenges that people with mental illness face.[4]

For larger jurisdictions, more sophisticatedtraining technologies may be available, including computer-simulated shoot/don't shoot scenarios or other media requiring officers to make split-second decisions involving people with mental illness.  In these situations, what the officer chooses to do determines what he or she sees next. These methods enhance critical-incident decision making skills and promote compliance withuse of force protocols. Thistechnology could beused inthis contextso officers can see the resultsoftheir decisions in a training environment.  Videotapes are useful for refresher courses or roll-call training, as they usually succeed in getting people talking. They can augment discussions and stimulate debate, but they are not the sole response to training needs.

Advanced training courses should typically be at least 40 hours and should be geared toward officers who will serve on special teams that focus on calls involving people with mental illness.  (See chart for topics.)

Consumers and their families, advocates, and mental health care providers should be included extensively in specialized training. Additionally, as specialized training entails more time than  in-service training, information provided to the officers should be more in-depth. The Memphis Police Department, Albuquerque Police Department, Montgomery County Police Department, Roanoke Police Department, Pinellas County Sheriff's Office, and Athens-Clarke County Police Department are among those law enforcement agencies that have developed a 40-hour advanced training course.

Ideally, class size for advanced training classes should be kept manageable to ensure a facilitator-to-student ratio that allows for total participation.  Some agencies may decide that only a special team of officers will receive this training course, while other departments will mandate the advanced training for all officers. The audience does not affect the information that should be included in an advanced training.  Field Training Officers and others engaged in training or supervising patrol officers and dispatchers should be required to attend the advanced training.

Advanced skills trainings should include all of the techniques referred to previously, including extended visits to local mental health facilities to learn about treatments offered and opportunities for computer simulations. As an additional consideration, an emphasis may be placed on less-than-lethal (LTL) alternatives and on education to destigmatize mental illness and lessen fear should be provided to enhance shoot/don't shoot decisions.

Communications personnel who work with law enforcement agencies play an important role in an agency's response to people with mental illness.  Training communications personnel is not possible for every law enforcement agency, especially where 911 services are under the jurisdiction of the county or larger municipality. When it is possible, however, law enforcement agencies should involve call takers and dispatchers in training to enhance law enforcement service to people with mental illness.

Training communications personnel is imperative because the nature of their actions will frame how much information callers provide to them and how callers perceive the agencies' sensitivity. These personnel also shape the responding officer's state of mind upon arriving at the scene by emphasizing information that can increase or decrease officer fear or other preconceptions.  The questions call takers ask and the information relayed by dispatchers ensure that responders have access to all possible information so that they are aware of disposition options. The responding officer can direct citizens to proper services, treat them effectively and with dignity, and de-escalate situations.

Example:  Houston (TX) Police Department

The Houston Police Department credits the training of dispatch and communications staff as a key to their success in working with people with mental illness. Personnel were trained to ask necessary questions in a timely and appropriate manner. The goal of this training is to ensure that responding officers are provided with as much information as possible