Wednesday, July 30, 2014

My turn: Looking back, moving forward — CIT

From page A4 | November 21, 2012 |

Editor’s note — This is part 2 of a three-part series of columns by Denise Marie Siino.

In Part 1 of this series, I said that Crisis Intervention Training field officer training includes learning new stabilization and de-escalation techniques to employ when facing a person with mental illness. Clinical and forensic psychologist Joel Dvoskin, PhD, once acting commissioner of mental health for the state of New York and current CIT trainer, said, in a nutshell, the objectives of CIT field training are to teach officers to:

• go slow, don’t push toward quick resolution;
• use words designed to make the person feel safer, not threatened;
• use words that lower anger, frustration and fear;
• express empathy.

The ultimate goal in any encounter with a mentally ill person is a successful outcome for both the officer — to retain control without having to use force, and the person — to get through the crisis safely. El Dorado County is fortunate that some of its officers (both sheriff and police) have already received this specialized training.

But there is more to the CIT program than just teaching effective field strategies and techniques. In its fullest form, CIT is much broader.

Stephen Golding, Ph.D., early forensic psychologist and adjunct professor at the University of Utah School of Medicine, said that the CIT program was born from the lack of an integrated system that brings together a diversity of disciplines and coordinates efforts to address the unique needs of the mentally ill.

Since the deinstitutionalization of the mentally ill in the 1970s and ‘80s, communities that were supposed to take over supporting and caring for these individuals lacked the funding, resources and expertise for the job. Suddenly, the mentally ill — with more freedom than they’d had in decades — were struggling to live productive lives and stay out of trouble. Family members had to battle with their loved ones to get them the help they needed, failing often.

Over large swaths of the country, things haven’t changed much in the last 30 years. Without the integrated support system Golding referred to, the mentally ill in most regions are still very likely to become trapped in a never-ending cycle of arrest, court, jail or mental evaluation/detention, arrest, and so on.

CIT is intended to break this cycle and provide a support structure to help the mentally ill individual and his family forge a different path and avoid a crisis that attracts the attention of law enforcement in the first place.

Pulling the skin away from CIT, we find that the skeleton is made up of multiple groups knit together like bones in a human framework. Each ‘bone’ is an agency interested in serving the best interests of the mentally ill (as well as those with other distinct mental and developmental disabilities) as an integral segment of the community at-large.

These agencies – having grown in wisdom and experience since the days of the 1970s and ‘80s – have a lot of heart, but until 2008 in El Dorado County, they did not have a central control center to help coordinate their activities. CIT provided a solution.

The ‘brain’ with the CIT model is a multidisciplinary team (MDT) of professionals representing these agencies that meets regularly to share information and confer about the best protocol for handling individuals who have been referred to the team for discussion.

El Dorado County’s MDT meets about every six weeks, and includes representatives from the Sheriff’s Department and Placerville PD, Mental Health, Adult Protective Services and Public Guardian’s offices, NAMI (National Alliance on Mental Illness), Jail, Parole, Probation, ALTA (serving people with intellectual and developmental disabilities), Community Health, Veterans Affairs, Patients Rights, DA’s and Public Defender’s offices, Animal Control, local alcohol and drug programs, and veterans and behavioral health courts.

Looking at the list of participants, the image of a safety net readily emerges. A person may be arrested and taken to jail, where she presents signs of mental illness; or taken on a 5150 hold to Marshall Hospital and referred to Mental Health; or maybe she is stopped by an officer and released, but the officer is nevertheless concerned enough about her mental state to refer her to the department’s CIT officer. In all of these scenarios, the person is now referred to the MDT.

Within the CIT program, the jail plays a unique role in helping to serve the needs of the mentally ill. A 1998 Bureau of Justice report states that 16 percent of all inmates nationwide (jail, state prison, federal prison) reported or were deemed to have a mental or emotional condition. Currently within the Placerville jail, 13 percent of inmates are being treated for mental illness. By making referrals to the MDT for discussion and follow-up, the mentally ill, once released from jail, become the focus of ongoing care rather than falling prey to the endless cycle of re-arrest.

Part 3 of “Looking Back, Moving Forward” will focus on how the existing CIT program in EDC can be improved.

Denise Marie Siino is a former writer for the Mountain Democrat and a current freelance writer. You can find her writing online at



Denise Marie Siino



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