Establishment of a Police Crisis Intervention Team in Tucson, Arizona:

Sometimes it Pays Off Not to be First

Laura J. Waterman, Ph.D., Carol Little, P. Lynn Mayer, MS, RN, SAMHC .......Lt. Stella Bay

Behavioral Health Services ..................................................................................Tucson Police Dept.

1930 E. 6^th Street, Tucson AZ 85719 ...................................................................270 S. Stone Ave.

(520) 617-0043 ext. 140 ............................................................................................Tucson, AZ

.................................................................................................................................... (520) 791-4499 ext. 1535

The Tucson Police Department (TPD) responds to approximately 300 calls for service per month involving individuals who are suicidal or present other behavioral health challenges. Of the 7204 such calls for service during 1999-2000, 123 resulted in the death of the individual. During this time period there were three incidents involving a suicidal subject in which officers were obliged to use deadly force to protect their life or the life of another. Use of deadly force is clearly an exception rather than the norm--only .0004% of calls involving individuals with behavioral health challenges led to use of deadly force by an officer.

During this same time period, the Pima County Sheriff's Office (PCSO) was involved in a "suicide by cop". The father of the victim, a retired police officer, strongly believed that if the responding officers had been more knowledgeable about mental illness the situation in which his son was involved might have ended differently. Joe Mucenski and his wife Margaret established a grassroots organization, the Crisis Intervention Network (CIN) committed to working towards establishing a Police Crisis Intervention Team (CIT) in Tucson, modeled after Memphis Tennessee's CIT. The core component of this model is the provision of 40 hours of training in behavioral health issues to approximately 20% of officers on the beat.

Behavioral health professionals from Tucson had previously traveled to Memphis in 1999 to look at the CIT there. For a number of reasons (different demographics, vastly different geography, different behavioral health system) it was determined that the Memphis model would not be effective in Tucson. Nonetheless, given TPD's determination that use of deadly force in even .0004% of calls was too much, coupled with the impetus provided by the CIN, a broad based effort to implement a different way for police to handle such calls was implemented.

The Community Rehabilitation Division of the University of Arizona sponsored a number of meetings with stakeholders from throughout the community. During these meetings the community was educated by Hank Steadman, Ph.D., of the National Gains Center for People with Co-occurring Disorders in the Criminal Justice System. Dr. Steadman has studied CITs in many cities and notes that in order for CIT to work effectively there are three required components: 1) training of police officers; 2) a "drop-off" site to which officers can bring offenders and get back out to the street in a timely fashion; and 3) adequate behavioral health supports available for after care--when the individual leaves the drop-off site.

Also during this series of meetings stakeholders spent significant time determining what the goals of a CIT model would be, how it could be implemented in Tucson, and how it could be funded. After a number of meetings attended by law enforcement, local hospitals and behavioral health providers, it became clear that the significant number of uninsured individuals involved coupled with the huge distances patrolled by the respective police departments (TPD, 226 square miles; PCSO, 9240 square miles) argued against the establishment of a single drop off.

TPD and the PCSO have worked together with behavioral health providers (including substance abuse and developmental disabilities services providers), local hospitals, individuals with behavioral health challenges and their families, advocacy groups, academia, and behavioral health funders. Law enforcement, and representatives of both advocacy groups and behavioral health agencies made additional trips to Memphis and to Albuquerque. The Director of the Drop Off Site in Tacoma came to Tucson to provide information about that program. Extensive correspondence via mail, telephone and e-mail took place with law enforcement and behavioral health staff in additional cities such as Anchorage Alaska, Houston Texas, Portland Oregon, and Akron Ohio.

The following components for an effective CIT program were identified and implemented:

• 40 hours of training for officers (target 20% of beat officers):

• 20 hours didactic classroom instruction on topics such as Overview of Mental Illness, Effective Communication, Developmental Disabilities, Psychotropic Medication, Legal Considerations, etc.

• 8 hours of field trips to sites including hospitals serving people with mental illness, day programs, and after-care providers

• 12 hours of role playing during which officers were required to role play situations in which they used the knowledge gained during the didactic presentations and field trips

• Increased efficiency at local hospitals facilitating quick turn-around by officers when they transported people to Emergency Rooms. This was brought about by having members of the core group (law enforcement, behavioral health, advocacy, criminal justice) meet with staff from each of the nine Emergency Rooms in Tucson (sometimes more than once) to discuss and resolve impediments to such a turn-around.

• Development of "6 minute training" modules regularly provided to all law enforcement personnel. These trainings reinforced the 40-hour training and also provided critical and concrete information for officers who had not gone through the 40-hour training.

Tucson's CIT program officially began with the graduation of its first class of CIT officers on 3/29/02. It is still too early to determine if the program is effective. The benefits of not being first are multiple. Tucson had the opportunity to examine the strengths and weaknesses of programs established by other cities. Establishment of relationships with both law enforcement and behavioral health professionals in other cities allowed stakeholders in Tucson to speak frankly with individuals in other cities when there was internal dissension about various facets in the program (e.g., specific topics to be covered in didactic training, extent of utilization of consumers of behavioral health services in role playing, etc.). While not explicitly stated in any city, we found that the partnerships forged among law enforcement, behavioral health, and funders were critical. By establishing that partnership from the very beginning, Tucson hopes to avoid some of the problems, which are inevitable when different cultures collide. Finally, Tucson hopes to share its experience with other cities seeking to implement different ways for law enforcement to safely manage situations in which persons with behavioral health challenges are in crisis.

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