According to The Sentencing Project, there are 2.2 million people incarcerated in the United States of America (Criminal Justice). Over the last 40 years, incarceration rates have gone up 500% (Criminal Justice). Mass incarceration is a reality in the United States of America. Some of the explanations for our nation’s high incarceration rate include law enforcement and policies that focus on tough punishments, longer sentencing, and the criminalization of mental illness.
People with mental illness have long been part of a societal shuffle in and out of one type of institution or another. As it began in 1955, deinstitutionalization came about as an effort to keep people with mental illness out of psychiatric hospitals to then offer community-based interventions (Deinstitutionalization). Institutionalization in psychiatric hospitals has long been thought of as an inhumane caging up of human beings. I’m not a fan of institutionalizing anyone, personally. As people were removed from psychiatric hospitals, however, communities were ill-prepared to offer vital treatment, supports and interventions. Fast forward to present day, 2019 and people with mental illness are now being institutionalized in jails and prisons.
The National Alliance on Mental Illness (NAMI) notes that during a mental illness crisis, people are more likely to be met with police intervention than mental health intervention (NAMI). In the era of mass incarceration, in the United States of America, 2 million people with mental illness have been incarcerated (NAMI).
As with many systems in our society, the criminal justice system is complex. It consists of a web of legal and social institutions whose purpose it is to enforce criminal laws. Prior to being charged and incarcerated, individuals first interact with law enforcement officers. During these interactions, people with mental illness are 16 times more likely to be killed by law enforcement officers than people without mental illness (Fuller, Doris, et al). Law enforcement officers are often faced with situations that they are not adequately trained or supported to navigate. Vermette, Pinals and Applebaum (2005) explains that outside of mental health professionals, law enforcement officers interact with people facing mental health crisis the most. Their study also revealed that law enforcement officers routinely express interest in receiving training to help them work through these crises.
A common intervention to help law enforcement officers respond to mental health crises has been the development of Crisis Intervention Teams (CIT) which has been around since 1988 (Watson & Fulambarker, 2012). CIT is a partnership between law enforcement, community and local mental health agencies. Watson, Ottati & Morabito (2010) noted that while implementation of CIT did not directly affect arrests, it was a factor in helping officers recognize the need to refer individuals to mental health services. Referring people to mental health services can reduce the number of individuals being incarcerated and direct people to much needed mental health supports. The collaboration of mental health, community and law enforcement is an integral part of society.
Addressing the criminalization of mental illness can eventually help reduce one part of the mass incarceration epidemic. So far, around 2,700 communities across America have implemented CIT programs but that number is not enough (NAMI). We still see many communities in need of interventions. One of the limitations of CIT programs has been the time it takes to provide in-class training to officers and the costs associated with training.
In 2015, an extended version of the CIT program was developed by the Albuquerque Police Department (Crisanti, Earheart, Rosenbaum, Tinney & Duhigg, 2018). The program, CIT ECHO (Extension for Community Healthcare Outcomes) goes above and beyond the CIT program and includes a model of continuing education using videoconferencing technology to ensure availability and access to departments nationwide. As a sustainable effort, it offers weekly programs and includes question and answer sessions which can greatly improve understanding and retention of information. This program also offers guidance to help jurisdictions develop and improve their own local policies (CIT ECHO). The CIT ECHO website offers care cards for individuals with disabilities, a blog, podcasts and a variety of information on important mental health topics.
Unfortunately, CIT ECHO was only funded for a period of three years by grants from the Justice and Mental Health Collaboration Program, Bureau of Justice Assistance and the U.S. Department of Justice and that funding has run out. Boetel (2019) described the program as having had a big impact on the way law enforcement interacts with mental health crises. In an article, he explained that upwards of 20% of law enforcement officers believed force was required to maintain officer safety prior to participating in CIT ECHO, however, after training participation only about 3% of officers maintained that belief. Programs such as these are vital for all communities. Not only can they help reduce conflict between individuals experiencing mental health crises and law enforcement officers, but they can provide officers with the support they need to cope with difficult real-time situations in a safe manner.
Mass incarceration remains a problem in the United States. According to Schneider, Gruman & Coutts (2012), some of the goals of a prison are to remove criminals from the general population to protect society from individuals who are threats, to punish these individuals and to reform individuals for re-entry into society when deemed applicable. Criminalizing mental illness only leads to more people being incarcerated instead of receiving much needed intervention, support and treatment. Once a person has an arrest record and has been incarcerated, their ability to obtain employment, housing or any assistance to reintegrate into society and function is reduced or in some cases permanently lost. This is not how to protect society. It’s punishment for having a stigmatized illness and it’s not reformation of any kind when a person with an illness ends up worse after incarceration.
We have seen the benefit of interventions such as CIT and CIT ECHO, but we are still only touching the surface of possibilities with such interventions. In a span of a few decades we went from CIT to CIT ECHO with promising results. While funding for the CIT ECHO program has run out, it is still actively running through the amazing work of volunteers. Interventions such as CIT and CIT ECHO are great examples of applied social psychology being implemented in law enforcement and the criminal justice system. These interventions can help improve group dynamics between law enforcement and communities and reduce biases around mental illness. Providing officers, as first responders, the tools they need to effectively work with people facing mental health crises can play a vital role in helping end an aspect of mass incarceration.
Boetel, Ryan. (2019) “Police Learn to Deal with Mentally Ill Residents.” Albuquerque Journal, Albuquerque Journal, www.abqjournal.com/1276467/police-learn-to-deal-with-mentally-ill-residents.html.
“CIT ECHO.” Crisis Intervention Team, www.gocit.org/cit-knowledge-network.html.
“Criminal Justice Facts.” The Sentencing Project, www.sentencingproject.org/criminal-justice-facts/.
Crisanti, Annette S., et al. “Beyond Crisis Intervention Team (CIT) Classroom Training: Videoconference Continuing Education for Law Enforcement.” International Journal of Law and Psychiatry, vol. 62, 2019, pp. 104–110., doi:10.1016/j.ijlp.2018.12.003.
“Deinstitutionalization: A Psychiatric ‘Titanic.’” PBS/Frontline, Public Broadcasting Service, www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html.
Fuller, Doris, et al. “Overlooked in the Undercounted THE ROLE OF MENTAL ILLNESS IN FATAL LAW ENFORCEMENT ENCOUNTERS.” Treatment Advocacy Center, doi:10.3897/bdj.4.e7720.figure2f.
“NAMI.” NAMI: National Alliance on Mental Illness, www.nami.org/learn-more/public-policy/jailing-people-with-mental-illness.
Pennsylvania State University World Campus (2019). PSYCH 424 Lesson 8: The Legal System/Criminal Justice Retrieved from https://psu.instructure.com/courses/1973019/modules/items/25635712
Schneider, F. W., Gruman, J. A., & Coutts, L. M. (2012). Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Los Angeles: Sage.
Vermette HS, Pinals DA, Appelbaum PS: Mental health training for law enforcement professionals. J Am Acad Psychiatry Law 33:42–6, 2005
Watson, A. C., & Fulambarker, A. J. (2012). The Crisis Intervention Team Model of Police Response to Mental Health Crises: A Primer for Mental Health Practitioners. Best practices in mental health, 8(2), 71.
Watson, A.C., Ottati, V.C., Morabito, M. et al. Adm Policy Mental Health (2010) 37: 302. https://doi.org/10.1007/s10488-009-0236-9