While the Substance Abuse and Mental Health Services Administration has said West Virginia has one of the highest rates of severe mental illness in the country, the state is one of a very few with no police agencies that undergo crisis intervention team training, a well-respected model that helps officers learn how to more empathetically and constructively communicate with people experiencing mental health crises, according to national advocates for the program.
Crisis intervention team training began in Memphis, Tennessee, in 1988 after police shot a mentally ill man wielding a knife. About 3,000 programs operate in the United States today. According to the University of Memphis CIT Center, only West Virginia, Arkansas and Alabama have no CIT-trained agencies.
The model is recommended by the National Alliance on Mental Illness, the American Association of Suicidology, Amnesty International, the White House Conference on Mental Health, the Department of Justice, the Department of Health and Human Services and SAMHSA, according to organizers in Memphis. It is also encouraged by the International Association of Chiefs of Police, according to Mike Woody, president of CIT International.
The curriculum is available online. Police agencies and mental health care providers who want to use it are free to adapt it for their own communities, at no cost. The only expense is officers’ time off the street, and perhaps accommodations for trainings away from home, or money to pay mental health workers to train, if they demand it.
Police who participate learn about signs and symptoms of mental illness, de-escalation techniques and resources in their community. Even more importantly, they establish relationships with local mental health care providers.
The self-selected participants — typically patrol officers — undergo 40 hours of training. But the real education begins afterward, according to Woody. Dispatchers are taught to send CIT-trained officers to mental health-related calls, when possible. They hone their skills and they become more familiar with mental health services.
“It’s not the 40-hour course that makes them an expert,” Woody said.
As use of force by police agencies is more closely scrutinized nationwide, Woody’s phone has been ringing off the hook with calls about the training.
“Over the last two years, it’s spread like wildfire,” he said. “We’ve definitely arrived.”
But both Laura Usher, manager for criminal justice and advocacy at NAMI, and Woody said they were unaware of any police agencies in West Virginia that have undergone the training.
Chuck Sadler, the state’s law enforcement professional standards coordinator, also wasn’t aware of any police agencies who had participated. He searched computer records and found no record of any trainings tagged “crisis intervention” or “CIT,” although he did find record of mental health-related trainings.
Several people in crucial positions in the state, though, said they would be open to a CIT program.
Last month, police shot and killed a man in Roane County after family members tried to obtain a mental hygiene petition for the man earlier in the day. And in Mercer County last month, police shot a man after they said he was “acting erratically” and pulled a replica gun from his pants. “Acting erratically” is often police speak for showing signs of severe mental illness or substance abuse.
Those are extreme examples, and the medical histories and any diagnoses of the men involved are unknown. But a 1999 study found that 10 percent of police contacts, nationwide, are with the mentally ill. And several studies suggest that CIT improves safety outcomes for both officers and the people they encounter.
Amy Watson, a professor of social work at the University of Illinois at Chicago who studies mental illness and the criminal justice system, worked on 2010 and 2011 studies that found that CIT-trained officers were more likely to direct people with mental illness to services. She also worked on a 2012 study that found CIT-trained officers used less force as subject resistance increased.
She stressed that the model involves not only training but collaboration with mental health providers and advocacy groups.
“The really important part is, you don’t buy a CIT curriculum and have someone come in and do that and leave,” she said.
In Belle, police encounter the same people with mental illness on a regular basis. Police Chief Darrick Cox says it’s often when they forget or choose not to take their medication.
“We deal, I think, way more often than people realize with people with mental illness,” he said. “The problem we have in West Virginia is there’s not a lot of places that do have resources for people with those conditions.”
One man gets arrested for domestic violence frequently, but his mother never shows up for the hearings. The Kanawha County Prosecutor’s Office asked them recently what was going on.
“I have to explain, we keep arresting because what else are you going to do with him?” he said.
Cox said he was frustrated because Kanawha County lacks places to take people. In North Carolina, where he used to live, he could take people to a local crisis center.
He didn’t know that Prestera has a crisis stabilization unit, although Kim Miller, spokeswoman for Prestera, noted the facility is not appropriate for some people.
She suggested that through a training effort, Prestera employees could educate officers on both the unit and other options available to them when the crisis center is inappropriate, including mental hygiene petitions and state hospitals.
“It would help officers to understand the whole mental health delivery system,” she said.
Miller said the company was not involved with Charleston Police Department’s efforts several years ago, but she was receptive to the idea of collaborating on a training in the future.
“I’ll go out on a limb and say Prestera is willing to help with officer training,” she said. “We would be more than happy to.”
She also said that Prestera has the ability not only to offer education to officers on mental illness, but adequate treatment capacity. Prestera has crisis stabilization units in Charleston, Huntington and Logan. She noted that patients must come to Prestera voluntarily, and police cannot force them.
“There is still a lot of stigma out there,” she said. “That stops people from getting help. It also stops officers from finding out too much about it.”
Laura Usher, manager for criminal justice and advocacy for NAMI, explained that when officers become more familiar with the mental health system, then they are more likely to match the person up with more effective treatment, and the problem Cox described — repeating the same encounters — becomes less likely to occur. That’s why ensuring a CIT program is a partnership, not just educational, is so important.
“I always see this as there is plenty of responsibility to go around,” she said. “The ultimate responsibility should be with the mental health system, not the police. At the same time, they have a responsibility to respond safely and be humane. I think most cops do not think they’re going to be social workers.”
She said the part of the training that includes interaction with people with mental illness is also an essential component. Police in CIT programs in other states have spoken to people who said, “When that police officer was kind to me, that helped turn my life around.”
“I think a light bulb often goes off in their heads when they talk to someone who has a mental illness who maybe has encountered police in the past but is doing really well now.”
State Police spokesman Lt. Michael Baylous said he wasn’t familiar with CIT training but said State Police does train some troopers in hostage negotiation, and that some detachments have programs with chaplains in place.
Police at several large agencies in West Virginia also said they do offer trainings for officers on de-escalation techniques.
But chiefs of the Huntington, Morgantown and Charleston police departments all confirmed they do not offer the training. And all noted that interactions with people in mental health crises are a regular part of the job.
Huntington Police Chief Joe Ciccarelli said they have a seven-person crisis negotiation team and a Prestera employee based at the police department who can refer people to services. He said his officers had trained on de-escalation.
“That could involve anything from a barricaded gunman to a mentally ill person on the bridge threatening to jump,” he said.
In Charleston, Police Chief Brent Webster vaguely remembers an attempt at a CIT training about nine years ago.
“I know it was a very worthwhile training and I’m still open-minded to it,” he said.
The way the psychologist involved remembers it, the mental health services weren’t there to back up the effort. David Clayman, the psychologist who helped organize, said that some states have mental health ERs that police frequent. He knows an on-call social worker who works at night in Boston.
“It’s not fair to them without being able to give them back-up,” he said. “It has to be a community-wide effort.”
West Virginia’s mental health system, he said, is behind.
“We were trying to do it on a shoestring and we needed a rope.”
Webster, like several other officers, agreed that police need to know the signs, know the resources, and be able to effectively communicate. But he also expressed frustration with a mental health system that is still lacking.
“These officers are not mental health counselors,” he said. “They shouldn’t have to be mental health counselors.”
He noted officers can’t implement best practices when encountering people in crisis if services aren’t readily available.
“We have to have a place to take people,” he said. “Otherwise, who else is gonna do it at 2 in the morning?”
Oftentimes they end up taking people to the ER, only to find themselves in a similar encounter with the same person a short time later.
“The officer can’t spend all his evening trying to find those services,” he said, “because he’s gotta take calls while he’s trying to find services.”
Morgantown Police Chief Ed Preston said his officers learn how to defuse situations and to determine when force is necessary. He cited times when officers have talked people off bridges.
“Some of my officers have been so involved they’ve actually gotten people into facilities for either physical or mental health,” he said.
He noted police agencies have limited resources, so he said they’ve chosen to incorporate “elements of CIT” into currently existing trainings.
“If we’re in class we’re not on the road,” he said.
Most agencies in West Virginia are small, with limited budgets.
Cox, the chief of the Belle police department, suggested that could be part of the reason West Virginia has no CIT-trained agencies.
“Because we are a small agency, both from a manpower and a financial standpoint, it’s sometimes difficult to justify sending someone to 40 hours worth of training versus possibly 8 hours worth of training,” he said.
Usher said the programs are sometimes harder for rural states to get started. But other rural areas have been successful when one larger agency took the lead, and several agencies pooled resources.
“You can create a partnership just by talking to each other,” she said. “It wouldn’t be that hard to get started.”
Woody, who is retired, used to serve as CIT coordinator for the state of Ohio. He said that in Ohio, where he lives, 60 percent of officers are CIT-trained.
Woody noted that parts of Ohio are much like West Virginia. In some areas, they have reduced the course to three days, or skipped the field trip to a mental health facility when the nearest one was too far away.
“You have to make accommodations,” he said.
There is talk in West Virginia about the need for the training. Patrick Kerr, a psychologist, West Virginia University professor and chair of a state subcommittee that focuses on EMS response to children’s behavioral and psychiatric emergencies, said he would be willing to help lead an initiative.
He said the subcommittee recognizes EMS workers need to improve their response during psychiatric emergencies. But he said he needs law enforcement, mental health care providers and preferably state lawmakers at the table to begin the process of implementing CIT training.
“We have to start somewhere,” he said. “I think the worst thing we could do is to not start to take any steps.”