APRIL 2019

Police-Mental
Health Collaborations
A Framework for Implementing Effective Law
Enforcement Responses for People Who Have
Mental Health Needs

Introduction

L aw enforcement agencies across the country are being challenged by a growing number of calls for service involving people who have
mental health needs. Increasingly, offcers are called on to be the frst—and often the only—responders to calls involving people
experiencing a mental health crisis. These calls can be among the most complex and time-consuming for offcers to resolve, redirecting
them from addressing other public safety concerns and violent crime. They can also draw intense public scrutiny and can be potentially
dangerous for offcers and people who have mental health needs. When these calls come into 911/ dispatch, the appropriate community-
based resources are often lacking to make referrals, and more understanding is needed to relay accurate information to offcers. As such,
there is increasing urgency to ensure that offcers and 911 dispatchers have the training, tools, and support to safely connect people to
needed mental health services.1

To respond to these challenges, police departments are increasingly seeking help from the behavioral health system.2 This trend is promising,
as historically, law enforcement and the behavioral health system have not always closely collaborated. Absent these collaborations, offcers
often lack awareness of, or do not know how to access, a community’s array of available services and alternatives to arrest, such as crisis
stabilization services, mental health hotlines, and other community-based resources. And even when offcers are fully informed, service
capacity is typically insuffcient to meet the community’s need. As a result, offcers experience frustration and trauma as they encounter the
same familiar faces over and over again, only to witness the health of these individuals deteriorate over time.

Police Departments Can’t Do it Alone

Many communities continue to face pervasive gaps in mental health services, especially crisis services, placing a
heavy burden on law enforcement agencies and, in particular, offcers. Without access to appropriate alternatives,
offcers are often left with a set of poor choices: leave people in potentially harmful situations, bring them to
hospital emergency departments, or arrest them.

Understanding a need for greater collaboration, many law enforcement and behavioral health agencies have begun taking important steps
to improve responses to people who have mental health needs. These efforts have led to improvements in practices, such as providing mental
health training to law enforcement workforces and including mental health, crisis intervention, and stabilization training as part of some
states’ law enforcement training standards. (Stabilization training refers to tactics used to defuse and minimize any harmful or potentially
dangerous behavior an individual might exhibit during a call for service.) Some of these communities also designate offcers to serve as part
of specialized teams to respond to mental health-related calls for service. But while these steps are commendable and signify widespread

Bureau of Justice Assistance

U.S. Department of Justice
 acknowledgment of the need to improve law enforcement’s responses to people who have mental illnesses, they also underscore
the need for more comprehensive, cross-system approaches.

Communities are learning that small-scale or standalone approaches—such as just providing mental health training or
having a specialized team that is only available on certain shifts or in certain geographical areas—are not adequate to achieve
community-wide and long-lasting impacts. They have also learned that even the most effective law enforcement responses
cannot succeed without mental health services that provide immediate crisis stabilization, follow up, and longer-term support.
Moreover, when there are limitations in data collection and information sharing, law enforcement leaders have a diffcult time
understanding whether the investments they have made in training or programs are working, because success is being defned
by anecdotes, impressions, or even by the media’s coverage of isolated, high-profle incidents instead of concrete measures and
outcomes.

To address these challenges, some law enforcement agencies have invested in comprehensive, agency-
wide approaches and partnerships with the behavioral health system. These cross-system approaches,
also known as police-mental health collaborations (PMHCs), build on the success of mental health training and
specialized teams by layering multiple types of response models—e.g., Crisis Intervention Teams (CIT),3 co-responders, and
mobile crisis intervention teams—and implementing one or more of these models as part of a comprehensive approach to meet
their needs.4 These agencies may also sometimes link their specialized teams to a designated ‘mental health’ offcer in every
precinct or neighborhood. PMHCs are distinguished by their leaders’ commitment to integrating responses to people who have
mental illness into the day-to-day functions of all offcers. In PMHCs, law enforcement executives include the initiative in their
agency mission instead of just assigning it to the exclusive domain of a specialized unit.

PMHCs feature strong, demonstrated commitment from law enforcement and political leaders; formal partnerships with
community-based mental health providers and organizations representing people living with mental illnesses and their
families; quality training on mental health and stabilization techniques that is provided to all offcers and 911 dispatchers; and
written procedures that are clear and adhered to by staff. And communities that create PMHCs are also committed to building
an adequate array of community-based services such as short-term crisis stabilization programs, in-home intervention teams,
and programs that can provide ongoing and intensive case management to people with complex mental health needs.

Police-Mental Health Collaboration Toolkit

For jurisdictions that are seeking to implement a new PMHC, the U.S. Department of Justice’s Bureau of
Justice Assistance provides additional background on PMHCs and the different PMHC response models
(e.g., co-responder teams) in the Police Mental Health Collaboration Toolkit.
Visit pmhctoolkit.bja.gov for more information.

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Using Data to Inform Success
Critical to the success of these cross-system PMHCs is the establishment of the baseline number of mental
health calls for service that the police department is felding (as a starting point) and other indicators of PMHC
effectiveness, and the use of that data to review progress and troubleshoot any challenges. By using data, leaders
have the ability to assess the impact of the approach over time and measure its success against the outcomes
that matter most. The four key outcomes identifed below, together provide a picture of whether or not a PMHC is
successful, recognizing that data limitations and local context may necessitate variation in what data communities
collect.

• Increased connections to resources: Offcers in communities that have PMHCs should routinely refer
people who have mental health needs to community services, and they should ensure a successful linkage
to the behavioral health system. In these communities, 911 dispatchers also play a critical role in collecting
mental health information and relaying it to offcers prior to their response to a call for service. As a result,
successful PMHCs see an increase in the number of people who have mental health needs connected to
appropriate services and resources in the community. Greater success in this area is possible to the extent
that adequate services are available in the community, 911/ dispatch capacity is increased, and offcers are
aware of how to refer people to behavioral health services.5

• Reduced repeat encounters with law enforcement: 6 A key measure of performance for a PMHC is
the number of people who have repeat mental-health related encounters with law enforcement. Ideally, as
PMHCs see an increase in their connections to resources and in offcer referrals of people to appropriate
services, they would likely also see a reduction in the number of repeat encounters because these
individuals are provided the care needed to reduce or prevent future crises.7 Thus, effective PMHCs ensure
that the number of people who have mental health needs making or generating repeat calls for service is
lower than the baseline number established at the start of the PMHC.

• Minimized arrests: With an increase in the availability of community resources and services, offcers
have a greater set of options/primary interventions other than arrest when responding to calls involving
people who have mental health needs. Since one of the primary goals of a PMHC is to connect a person to
mental health services (especially for low level and nonviolent offenses, like trespassing and vandalism, in
which arrest is at the discretion of the offcer and the person does not pose a threat to public safety),8 having
more options should ideally result in a lower rate of arrest among people in this population. Additionally,
PMHCs are more successful when offcers are provided with reliable information about a person’s mental
health needs prior to responding to a call. PMHCs should track the full range of disposition outcomes for
mental health calls for service to analyze any trends or fuctuations that occur and increase their attention to
the rate of these arrests.

• Reduced use of force in encounters with people who have mental health needs: A critical
measure of performance for a PMHC is the frequency of use of force during encounters with people who
have mental health needs. Jurisdictions must determine what constitutes use of force in the context of the
PMHC (e.g., use of handcuffs during transport, hands-on maneuvers) so consistent analysis is possible
in the future. With training and a comprehensive PMHC in place, police offcers are better able to manage
encounters with people experiencing a mental health crisis, and force is then proportionate to the situation
the offcer encounters. It is important to track and analyze this outcome for both mental health calls and
non-mental health calls for service.

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 While law enforcement agencies must partner with the behavioral health system and other community supports to make a
PMHC successful, offcers and 911 dispatchers are often the frst ones interacting with people who have mental health needs,
especially during crisis situations. Therefore, the success of a PMHC is largely determined by the level of engagement and
commitment of law enforcement executives and the buy-in from their workforce. Thus, this framework’s primary audience
is law enforcement executives. It aims to inform and inspire such executives by providing examples of how PMHCs are
improving key outcomes in police departments across the country. The framework also provides a list of six questions that law
enforcement and political leaders may ask to assess their current responses to people who have mental illnesses and identify
steps to improves those responses.

The Six Questions Law Enforcement Leaders Need to Ask to Develop and
Sustain a Police-Mental Health Collaboration
Whether they are seeking to either implement a new PMHC or to improve an existing one, law enforcement leaders should
consider the following six questions to help determine whether their current responses are comprehensive, identify areas in need
of improvement, ensure that they are conducting ongoing quality reviews, and ultimately, whether their PMHCs are resulting
in the aforementioned four key outcomes. Albeit not a step-by-step guide, by answering these six questions, law enforcement
executives can work with their behavioral health counterparts to assess their community resources and better understand what
necessary additions and changes are needed. The questions, then, are also designed to assist these leaders in executing changes
to produce measurable progress in reducing the number of people who have mental illnesses in their communities who come
into contact with law enforcement.

1. Is our leadership committed?

2. Do we have clear policies and procedures to respond to people who have mental health needs?

3. Do we provide staff with quality mental health and stabilization training?

4. Does the community have a full array of mental health services and supports for people
who have mental health needs?

5. Do we collect and analyze data to measure the PMHC against the four key outcomes?

6. Do we have a formal and ongoing process for reviewing and improving performance?

Many agencies can likely provide excellent examples of what successfully addressing one or more of these questions looks
like, but only a small number of jurisdictions to date have suffcient answers to all of the questions above. If law enforcement
executives thoughtfully consider each question, and regularly revisit them, they will be able to determine whether and to what
extent their efforts are having a community-wide impact and are built for long-lasting success.

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 1 Is Our Leadership Committed?

Are law enforcement and behavioral health executives fully invested in implementing and sustaining a PMHC? Have leaders
publicly indicated that effectively responding to people who have mental health needs is essential to the law enforcement
agency’s mission? Are there champions within the agency that are empowered to develop, implement, and improve the
collaboration? Are staff recognized and rewarded for engaging in day-to-day behavior that supports the goals of the PMHC?

Why it matters
PMHCs have real-world implications. They can help communities address challenges like the toll that repeated arrests and police
encounters take on people who have mental health needs. They can also help ensure offcer well-being and allow offcers to focus
on public safety and addressing violent crime. These collaborations often rely on the strength and vision of law enforcement
executives (and their behavioral health counterparts) to convey the importance of the PMHC and to lead by example. Law
enforcement leaders who demonstrate their commitment to the PMHC through concrete action (such as developing new policies
and procedures and rewarding staff who consistently act in support of the goals of the PMHC) fnd that their offcers are more
likely to share in the vision. When these leaders become more invested in the collaboration, communicate its importance to all
staff, provide incentives for involvement, and incorporate the goals of the PMHC throughout the agency, a trickle-down effect
often occurs and more support and buy-in from staff follows. With this buy-in and support, the goals of the PMHC are part of the
fabric of everyday policing.

What it looks like

✓ Law enforcement leadership support: The top law enforcement executive sets the tone in the agency for the
collaboration and is most critical to its success. The executive is the highest-level leader to serve as the “champion,”
has the power to reach out to jurisdictional leadership for support (e.g., commissioners, mayors, and legislative bodies),
and provides direction to administrators and managers to secure agency-wide commitment. These leaders reach across
systems to develop relationships with executives in the behavioral health system to get buy-in for the collaboration,
promote the initiatives to the public and internally in their agencies, and coordinate efforts with advocacy organizations.

✓ Partnership with community champions: In addition to developing strong partnerships with behavioral health,
law enforcement also engages local community organizations and advocacy groups that represent consumers of
mental health services and people with lived experience and their family members. Community champions engender
support and buy-in from local agencies, bringing partners together that might not otherwise have a strong record of
collaboration. With frsthand knowledge of how to navigate the behavioral health system, these groups are also able to
assist in the PMHC planning process by contributing feedback on developing policies and procedures and building the
core components of the PMHC. Advocacy groups are able to mobilize their constituencies to convince legislators and
other key stakeholders to help fund PMHC response models and initiatives. They are also instrumental in marketing the
initiatives to the community, which helps strengthen law enforcement’s community ties.

✓ Interagency workgroup: A formal interagency workgroup (including law enforcement, behavioral health, and
government and community-based organizations) plays a vital role in bringing the partner agencies together to
regularly plan, implement, and assess the success of the PMHC. An effective workgroup is refective of the community’s
demographic composition (e.g., racially and economically) and includes members from not just law enforcement and
behavioral health, but also local advisory groups, criminal justice coordinating councils, public safety answering points
(e.g., 911 dispatchers), hospitals, courts, and corrections, as well as people who have mental illnesses, family members,
and other advocates who have a stake in the success of the collaboration. Memorandums of understanding (MOUs)

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 are created to outline the responsibilities of the partners in the interagency workgroup, such as how often meetings
will occur, which staff member(s) will attend, members’ responsibilities to subcommittees, funding, and other agency
commitments. Workgroup members ensure that their participating agencies are promoting the PMHC and its milestones
for success within their agencies, and help to assess progress toward agreed upon goals, recommending changes to
address challenges when necessary.

✓ Designated chairperson and project coordinator to oversee the PMHC: The law enforcement executive establishes
the interagency workgroup, which appoints a chairperson from the law enforcement agency or behavioral health system.
The chairperson oversees the implementation of the PMHC community wide and ensures all efforts and response models
adopted ft together to achieve the PMHC’s goals. A coordinator is also designated who is given authority (as clearly
represented in the agencies’ organizational charts) and has demonstrated a commitment to the PMHC. The coordinator
is selected to oversee the day-to-day operations of the PMHC and report back to the chairperson of the interagency
workgroup on the overall implementation and success of the initiative. The coordinator will regularly evaluate the
collaboration (e.g., review data on performance and adherence to policies and procedures) to ensure operations are in
line with the PMHC’s mission, as well as coordinate outreach and engagement with other partners. The coordinator
also organizes subcommittees, facilitates planning meetings, builds agendas, and makes recommendations to the
interagency workgroup.

✓ Funding and resource allocation: Local leadership (including elected offcials) designate funds for the collaboration
(e.g., funding specialized training and education, authorizing funds to pay for overtime, and allocating funds for PMHC
resources, such as vehicles and offce space). The fnancial investment can vary (e.g., funding a part-time case manager
position four hours a week), but designating funds and resources to support the PMHC demonstrates to staff that the
collaboration is an agency and community priority worthy of fnancial investment. Longer-term funding efforts are
driven by performance data and other needs assessments.

✓ Ongoing internal and external recognition of the initiative: Law enforcement leaders help to affect a cultural shift
by modifying offcers’ performance evaluations to include the goals of the collaboration, publicly recognizing staff who
employ skills to defuse situations, developing commendations or other awards for exemplary staff, and recognizing
police and supervisors who volunteer for PMHC positions. These leaders also make it clear that the initiative is part of the
overall mission of the department to combat any bias or stigma that staff might hold about collaborating with behavioral
health not being true police work.

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IN PRACTICE | Effective Leadership in Action, Portland, ME
The Portland Police Department (PPD) implemented their PMHC out of a proactive effort by their leadership, a
core collaborative workgroup, and a fully invested department to improve their responses to people who have
mental illnesses. The commitment from leadership drove a shift in culture in the department that began in the
1990s, with offcers slowly, then enthusiastically, embracing new models and interventions such as CIT training
and a mental health liaison program, as well as a year-long internship program for Master’s level students to
assist in responding to calls for service with offcers.

In place now is a robust program that includes a full-time behavioral health coordinator, mental health liaison,
and substance use liaison. Additionally, 100 percent of the offcers on the force are mandated to complete CIT
training,9 dispatchers receive training on how best to respond to people who have mental health needs, and PPD
has implemented a mental health liaison internship program.

Since the start of these efforts, the police chief and other leaders have been able to secure continued funding
from the city’s operating budget to ensure the behavioral health coordinator was expanded to a full-time position.
The chief was also able to secure additional funding from a local nonproft provider to continue the mental health
liaison position, as well as secure a commitment from the department to direct funding from the drug forfeiture
program to support a full-time substance use liaison.

The behavioral health coordinator role is integral to the day-to-day operations of Portland’s PMHC, managing the
mental health liaison and co-responder program and facilitating offcer training. The coordinator also oversees
a robust working group, the Cumberland County Crisis Providers Meeting, which includes people from the
emergency departments, inpatient facilities, substance addiction and mental health partners, shelters, and other
community organizations. This group, which has convened for more than 10 years, provides an opportunity for
community leaders to come together to discuss the PMHC, strengthen their collaboration, and discuss changes
the agencies might be seeing in their staffng or services. A universal release of information developed for all the
providers in attendance allows them to discuss clients they have in common. The workgroup members use these
meetings to discuss issues that may arise with these individuals, which allows the behavioral health coordinator
and mental health liaison opportunities to form relationships with the provider organizations in attendance and
better connect their clients to services in the community.

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 2 Do We Have Clear Policies and Procedures to Respond to People
Who Have Mental Health Needs?

Does the law enforcement agency have documented policies and procedures for how to respond to people who are experiencing a
mental health crisis? Do these policies and procedures account for the jurisdiction’s PMHC response models and for each instance
in which law enforcement interacts with people who have mental health needs (e.g., dispatch, at the scene, and follow-up)? Do staff
have a clear understanding of these policies and procedures and their roles in executing them?

Why it matters
Written policies and procedures that are communicated clearly to staff are critical to the overall success of a PMHC and empower
offcers to take actions that can enhance their safety and the safety of others. When policies are in place for each type of instance
where offcers interact with people who have mental health needs, offcers are equipped with the knowledge to consistently
respond to common events. Combined with skill enhancement and training, clear policies also reduce overall risk for the
department. The PMHC will only realize success, and policies and procedures will only be effective, when these policies and
procedures are disseminated, followed, and enforced by leaders in both the law enforcement and behavioral health agencies.

What it looks like

✓ Comprehensive process review: Prior to the creation of any new policies or procedures, the law enforcement agency
conducts a comprehensive process review of current policies and procedures for encounters with people who have mental
health needs. This process review allows the agency to see how people who have mental health needs fow through the
criminal justice system and the ways in which police offcers regularly interact with them. With proper planning and
analysis, the agency can address the full range of issues that offcers encounter and reduce opportunities for ambiguous
responses during an encounter or call for service. A useful end product of this review is a process fow chart that provides
staff with a visual depiction of how people who have mental health needs fow through the criminal justice system. It can
also show all potential dispatch and disposition outcomes to help ensure that the policies and procedures account for all
possible scenarios and outcomes.

✓ Selected PMHC response models: Based on assessed community needs, law enforcement and behavioral health
system partners select a primary intervention or a combination of approaches that their jurisdiction will adopt. The
goals of these response models are then integrated into the agencies’ missions and community-wide initiatives. The
interagency workgroup starts the process of building new policies and procedures for each response model chosen. People
who have mental illnesses, their family members, and advocacy organizations who represent them are involved in the
conversations that determine which PMHC response model(s) are selected.

✓ Comprehensive, clearly written policies and procedures: The law enforcement agency has written policies and
procedures in place that have been provided to staff, have a clear purpose, and illustrate to supervisors what steps they
should take to implement them. These policies and procedures outline roles and responsibilities of all agency staff
members, defne frequently used terms, give specifc response guidelines for scenarios that offcers and staff frequently
encounter, and are mindful of offcer safety and the potential volatility of encounters. When writing their policies and
procedures, law enforcement consults with their behavioral health system counterparts and advocacy organizations to
ensure they are appropriate from the behavioral health perspective and from that of people who have mental illnesses.
Law enforcement also acts as a resource for the behavioral health system as it creates policies and procedures to ensure
they align with offcers’ needs, culture, and the community’s perspective.

✓ Information-sharing agreements: These agreements establish what information can be shared among the partners

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 during an encounter (such as physician information, diagnoses, or recent hospitalizations) and give law enforcement
and mental health staff the ability to identify a shared population of people who have mental health needs. The
interagency workgroup aids in the development of these agreements and facilitates conversations among relevant
partners, better equipping offcers, dispatchers, and others to stabilize an encounter with a person who has mental health
needs. This information also enables law enforcement staff to connect people to needed services and supports, reduce
potential injuries to offcers and people who have mental health needs, and arrive at the best disposition. In addition to
agreements involving medical and protected health information, the interagency workgroup also develops a data-sharing
agreement(s).

✓ Staff awareness of policies and procedures: Written policies and procedures are posted and circulated to all staff of
the partnering agencies, and supervisors are held accountable for ensuring that their staff understand each new policy or
procedure and have received training on how to employ them. These policies and procedures are transparent and posted
online for the public to view. Staff are notifed when changes to the policies or procedures take place.

✓ Regular review of policies and procedures: Law enforcement and behavioral health system leaders assess whether
established policies and procedures are being followed. In conjunction with the project coordinator, the interagency
workgroup conducts regular reviews of the policies and corresponding procedures and ensures that they are being
communicated to all supervisors (and their direct reports). Mechanisms are also in place to make sure that these policies
and procedures are meeting the needs of the community, and that the community has an opportunity to offer feedback.
Periodically, the interagency workgroup revisits all policies and procedures, analyzes them against any internal or
community feedback, and makes recommendations for needed changes.

Types of PMHC Response Models

PMHC response models are the cornerstone for comprehensive, cross-system responses to people who have mental
health needs. The leadership team must select the model(s) most appropriate to address the community’s needs.
These models are not mutually exclusive, and, depending on their contexts and needs, jurisdictions often adopt and
layer multiple response models with comprehensive training and data-driven management to build a comprehensive
initiative. For additional information, support, and resources on these models, visit the Bureau of Justice Assistance’s
PMHC Toolkit, pmhctoolkit.bja.gov. Below are four of the most common PMHC response models.
Crisis Intervention Teams (CIT): These widespread, specialized teams are composed of offcers who receive
specialized training to respond to mental health calls. CIT offcers are dispatched to mental health calls or assist
offcers who are not CIT trained.10
Co-responder Team: Specially trained offcers and a mental health crisis worker respond together to address
mental health calls. Most commonly, they ride in the same vehicle for an entire shift, but in some agencies, the crisis
worker meets offcers at the scene, and they handle the call together once the crisis worker arrives.
Mobile Crisis Team: A team of mental health professionals, skilled at helping stabilize people during law enforcement
encounters as well as general crisis, available to law enforcement and the community. These teams are available to respond
to calls for service with the goal of diverting people from unnecessary jail bookings and/or emergency room visits.
Case Management Team: A team of behavioral health professionals (with or without offcers) and peers that
provide outreach, follow up, and ongoing case management to select priority people, such as repeat callers of
emergency services. Offcers do not treat or diagnose the individuals but work with mental health professionals to
develop solutions to reduce repeat interactions. Case management is often used as a proactive response in addition
to other selected PMHC response models.

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 IN PRACTICE | Building a New Program with Clearly Defned Policies
and Procedures: 911 Crisis Call Diversion Program, Houston, TX
The Houston Police Department (HPD) Mental Health Division (MHD), in partnership with The Harris Center
for Mental Health and Intellectual and Developmental Disabilities (the Harris Center), operates a multi-faceted,
successful PMHC to respond to people in mental health crisis. Houston’s PMHC response models and initiatives
include: a CIT training program for all cadets,11 co-responder and homeless outreach teams, and a chronic
consumer stabilization unit. While already using a comprehensive approach, HPD’s coordination with the Harris
Center helps them to regularly assess their models and initiatives and make changes as needed.

In 2015, the MHD identifed a new and innovative opportunity to help people in mental health crisis while relieving
fnancial strain on both the criminal justice and behavioral health systems. This early intervention program, called
the 911 Crisis Call Diversion (CCD) program, places mental health phone counselors inside Houston’s Emergency
Communications Center to work directly with 911 call takers and dispatchers to identify and divert callers with
non-emergency mental health concerns away from police or fre/EMS.

To develop this new program, the Houston PMHC frst created a response logic tree (or process map) to defne
when 911 operators could determine that a call was eligible for mental health counselors to intervene and establish
how they should respond while accounting for a variety of possible scenarios. HPD and the Harris Center then
developed operational guidelines and protocols and rolled them out during a six-month pilot period to ensure they
were appropriate for the new program.

During this pilot period, they were able to establish with a great amount of certainty what a majority of their calls
would look like, what phone counselors should expect when on a call, and what to do in specifc scenarios. Based
on these experiences, they also learned that while they were expecting the CCD program to save money and time
for the police and fre departments, they could also use it to make more appropriate referrals in the community.

After one full year of implementation, with clearly developed policies and procedures in place, the CCD program has
seen signifcant change in how calls are handled. In one quarter of operation, they were able to divert both the fre/
EMS and police from the scene for more than half of calls received. In a short period of time, the unit has shown how
important it is to the overall functioning of the department and how resources have been saved as a result.

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 3 Do We Provide Staff with Quality Mental Health and
Stabilization Training?

Is basic mental health awareness and stabilization training provided to all law enforcement employees at all staffng levels—
recruit, in-service, and specialized? Is this training offered in coordination with mental health partners? Are the voices of
people who are living with mental illnesses and their families incorporated into the training?

Why it matters
Learning how to defuse situations is foundational to the goals of all PMHCs and helps offcers better recognize and address
the behaviors they encounter in many mental health calls for service.12 When offcers receive high-quality mental health and
stabilization training, they are better prepared to use techniques to stabilize and defuse encounters when responding to people
who have mental health needs. While training alone does not ensure an improved response to people who have mental health
needs, it is essential to equip offcers, supervisors, 911 dispatchers, and mental health staff with the knowledge and support they
need to take actions that are grounded in current research and practices. Such training promotes the safety of offcers and all
involved.

What it looks like

✓ Knowledge and skills training for all staff: Mental health and stabilization training occurs for all agency staff at the
beginning of their tenure with the agency and then continually throughout their service to make sure their skills refect
any changes in systems, policies, or evidence-based practices. The knowledge and skills-based training that a jurisdiction
includes in its training curriculum varies depending on the needs of the particular jurisdiction, staffng structure,
and culture,13 but at a minimum the law enforcement workforce receives training on basic mental health awareness,
recognizing the signs and symptoms of mental illness, and how to manage a person in crisis. Table 1 below provides a
list of common basic PMHC training topics.

TABLE 1. BASIC PMHC TRAINING TOPICS14

Overview of Mental Illness and Wellness
Compassion Fatigue/Vicarious Trauma and Offcer Selfcare
Cultural Sensitivity
Disorders in Children—Autism and Developmental Disorders and Disruptive, Impulse-Control, and
Conduct Disorders
Gender Sensitive Responses
Identifying Signs, Symptoms, and Behaviors of Mental Illness
Stigma
Substance-Related, Co-Occurring Mental Health and Addictive Disorders
Suicide Intervention and Non-Suicidal Self Injury

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 Trauma-Informed Responses—Basic
On-Scene Assessment and Response Protocols
Active Listening, Nonverbal Communication
Crisis De-Escalation, Stabilization Techniques, and Mediation Skills
Offcer Safety
Use of Force
Disposition and Resource Options
Community Resources and After Hours Referrals and Resources
Homelessness and Housing Alternatives
Involuntary Commitment Process
Military Personnel/Veterans Resources and Specifc Needs
Transportation of People Who Have Mental Health Disorders, Intellectual and Developmental Disorders (I/DD),
and Physical Disabilities
Understanding of PMHC Policies and Procedures

✓ Training aligned with staff roles and experiences: Training is consistent with staff roles, level of engagement, and
interest in selected PMHC response models, as well as skill set and expertise. Topics and skills vary depending on the
type of training delivered; for example, a CIT training takes a deeper dive into subject matter than training included as
part of an academy for new recruits. Skills topics needed for offcers may also be different than training needed for 911
dispatchers. Leadership develops tailored training curriculum to equip staff for their jobs, particularly for specialized
units or positions in the department. Table 2 lists advanced topics that are typically included in trainings for specialized
teams or offcers that play a particular role in a PMHC response model.

TABLE 2. ADVANCED PMHC TRAINING TOPICS15

Assessment, Commitment, and Legal Considerations

Data Collection and Demonstrating Program Success
Guardianship, Power of Attorney, and Issues of Aging
Information Sharing across Law Enforcement and Mental Health
I/DD and Neurodevelopmental/Neurocognitive Disorders—Adults
Mood, Psychotic, and Personality Disorders
Motivational Interviewing
Post Incident Debrief and Departmental Support
Procedural Justice, Fairness, and Bias

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Psychopharmacology and Medications
Responding to Media and Community Inquiries/Outrage
Specialty Courts and Other Diversion Options
Stakeholder Engagement
Trauma-Informed Responses—Advanced

✓ Training instruction and delivery: Regardless of the curricula chosen, content is taught by law enforcement and
mental health provider instructors, subject experts, and others with frst-hand knowledge, like people who have
mental illnesses and their family members, as appropriate. Trainings taught by people with lived experience and their
family members give offcers the opportunity to informally interact with people who have mental health needs and
their families in a non-crisis setting. The delivery of training comes in both experiential and hands-on opportunities
if possible, but also in lecture-style presentations, simulations and/or virtual training, scenario-based role playing,
group problem-solving exercises, site visits to mental health facilities, and ride-alongs so that coursework is varied and
accessible to people who have different learning styles. Refresher training is provided periodically.

✓ Evaluation of training: Trainings are regularly evaluated to assess their overall quality and impact. A review process
ensures that the curriculum is meeting its intended purpose of preparing law enforcement staff to more effectively
respond to mental health calls and defuse these encounters. Pre- and post-testing of the training participants ensure that
participants have developed new or enhanced existing skills and knowledge as a result of the training. Evaluations are
reviewed, and modifcations to the training curriculum are made based upon the fndings. There is also a process for the
interagency workgroup to periodically review the curriculum and assess the need for changes based on community needs
or crime trends. Using results from these training evaluations, supervisors assess how well staff understand the training
content and use it in their day-to-day activities.

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 IN PRACTICE | Using Coordinating Councils to Promote Training
Across the State: State of Missouri
In partnership with their mental health providers, law enforcement leaders in Missouri developed a successful
multi-pronged approach to training offcers using a statewide CIT curriculum that every local jurisdiction could
adapt. The training includes a core 32-hour base curriculum covering 19 mandatory topics, but each jurisdiction
can customize their remaining 8 hours of training (selecting from more than 23 electives). Elective topics cover
areas such as homelessness, trauma, offcer suicide, and “suicide-by-cop” prevention.

As with many states, Missouri offcials determined that while some of their larger cities like St. Louis had the
resources and funding to implement the training, other smaller suburban and rural locales did not. To address this
challenge, offcials allowed some of the smaller jurisdictions to send an offcer to larger jurisdictions offering the
training once a week for fve weeks to complete CIT training.16

Most importantly, Missouri offcials leveraged a network of coordinating councils to customize the curriculum
and training approach based on local needs. Each council covers a geographic area comprised of local law
enforcement agencies and community and state-based organizations. The councils meet at least quarterly to
develop local training schedules, adapt the state’s CIT curriculum to meet their local needs, determine which
electives from the state curriculum they will adopt, and develop relationships with providers and individuals to
deliver core components of the curriculum. The state also hosts a CIT conference bringing together members from
all of the coordinating councils each year. During these events, members vote on what topics to include or modify
in the state’s CIT curriculum and receive additional professional development.

The state also provides ongoing mentoring and specialized training through a network of 31 mental health
professionals called community mental health liaisons who are available to every law enforcement department in
Missouri. Similar to a traditional co-responder team, these liaisons respond to calls and provide training on complex
cases to jurisdictions and individual offcers that may otherwise not have access to more advanced training.

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 4 Does the Community have a Full Array of Mental Health Services
and Supports for People Who Have Mental Health Needs?

Does an array of mental health and community services exist for people who are experiencing a mental health crisis? Are the
services regularly utilized by the PMHC partners? How often are these services available when law enforcement encounters a
person in need of them? Have the PMHC partners worked together to leverage additional funding to address gaps in service
capacity?

Why it matters
Law enforcement offcers can more effectively respond to people who have mental health needs and connect them with appropriate
community supports when a full range of mental health and community services is available. Offcer awareness of these services
further expands the disposition options available to them, reducing the need to arrest as the only option for these encounters. These
connections can provide opportunities for long-term treatment. And when long-term treatment options are available, offcers are
better able to connect people who have more complex needs to these supports in an effort to reduce future encounters and arrests.
While intended to be a seamless continuum of services, in practice, law enforcement only controls a subset of these services, namely
the PMHC response models (e.g. CIT or co-responder teams). In collaboration with the behavioral health system, law enforcement
can help to ensure that the full array of service options (e.g. mobile crisis, crisis stabilization facilities, etc.) is available and that
offcers are aware of how and when to use them. When law enforcement helps identify missing services and their behavioral health
counterparts prioritize existing resources in support of the PMHC, the behavioral health system also benefts. Together, these
systems can make a strong, data-driven argument to elected offcials for more funding to increase service capacity.

What it looks like

✓ Inventory of existing services: Law enforcement leaders partner with their behavioral health counterparts and other
community organizations to inventory services in the community. Services appropriate for this inventory include those
that address crises (e.g., diversion or crisis facilities, single-point of access facilities, shelters, and detox/rehabs) and longer-
term services to reduce repeat encounters (e.g., Assisted Outpatient Treatment, Assertive Community Treatment, outpatient
treatment, and housing programs and services). This inventory helps partners identify if there are major gaps in the array
of service options for this population, how they can access these services, and eligibility restrictions, such as insurance
limitations, diagnostic criteria, or other thresholds. One of the more common techniques used to develop this inventory, or
system map, is Sequential Intercept Mapping.17 In addition to helping promote collaboration and partnership between the
criminal justice and mental health partners involved, the mapping helps identify diversion opportunities and resources
for people who have mental health needs. For instance, the inventory could reveal that there are crisis services but that the
community lacks long-term interventions. Once the interagency workgroup reviews the inventory, it is better positioned
to identify services to fll those gaps and determine if additional PMHC response models or services are needed in the
community.

✓ Assessment of program and service capacity: The interagency workgroup determines whether the existing services and
programs are operating at the scale required to meet the needs of the community. This assessment is strengthened when
it is informed by data collected on the utilization rates for all existing services and patterns of instances in which a given
service is requested but not available. A designated individual or subcommittee is identifed to oversee the data collection
process and works in tandem with the interagency workgroup to assess the PMHC’s resource capacity and compare
it to the volume of what is actually needed on an ongoing basis. This assessment examines which resources may be
underutilized due to lack of awareness, over-subscribed because there are more people eligible than spaces available, and
which services may not align with what the community needs.

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 ✓ Prioritized behavioral health resources and increased funding: Law enforcement and behavioral health agencies
partner to prioritize available services for people who have mental health needs. The interagency workgroup supports
these efforts by examining the data and pointing to areas in need of additional service capacity. Law enforcement leaders
aid their behavioral health partners in seeking support and buy-in from elected offcials by combining their data and
showing a specifc, quantifed need for additional services. Advocacy groups also help to rally support (and members)
around these initiatives to bring additional legislative buy-in and potential funding.

IN PRACTICE | The Evolving PMHC: A Data-Informed Approach

to Assessing Services and Improving Responses in Tucson, AZ
Since 2000, the Tucson Police Department (TPD) has been working to effectively respond to people in mental health
crisis. While they initially began their efforts by employing only acute crisis mobile teams (CMT), TPD’s use of data
led them to identify limitations in using just one response model and a need for a more comprehensive PMHC to
better respond to this population. For instance, while offcers appreciated having access to trained clinicians to help
them divert people to behavioral health services, they also expressed concern about how long it took the clinicians
to respond—sometimes up to an hour after the offcer arrived on scene. Also, TPD determined that the local hospital
was unable to keep up with the demand for stabilization services for people in crisis.

Equipped with the number of mental health calls they received per month, the estimated time it took to respond to
these calls, the number of mental health and law enforcement staff deployed in the CMTs, and other relevant data,
TPD’s Mental Health Investigative Support Team (MHST)—a specially trained unit of the TPD that serves as a mental
health resource for other offcers—community members, and health care providers identifed the need for adding a
co-responder team to their resources to address the needs of the community.

To create the co-responder team, they suggested the following: (1) change the staffng of the CMT to one clinician
instead of two, and deploy the second clinician to the new co-responder team with an offcer, thereby cutting down
wait times offcers were experiencing (as this would be a direct police resource); and (2) change the new team’s
primary focus to answering 911 calls, while the CMT would focus on proactive community outreach and engagement.

MHST presented the plan to TPD and the Pima County Regional Behavioral Health Authority leadership and
emphasized the cost savings both partners would realize if a co-responder model was implemented in addition to the
CMTs. The plan would also beneft the local hospitals by decreasing crisis placements and promoting stabilization for
people in crisis or who have mental health needs.

With these changes approved and implemented, TPD has been able to develop a more comprehensive partnership
between law enforcement and the behavioral health system. Instead of standalone programs working in silos, system
partners now work in collaboration and have utilized their resources to reduce wait times, more effciently staff both
the CMTs and co-responder teams, and link more people to services. The CMTs and the co-responder teams have
been able to take full advantage of the city’s 24-hour crisis center, which opened in 2011 as an initial attempt to help
stabilize people in crisis. Law enforcement has also seen a reduction in wait times due to the implementation of the
co-responder team; and the co-responder team has helped MHST tailor their case management approach to focus on
involuntary commitments, linking these individuals to services before they are in crisis, and signifcantly decreasing
the number of involuntary commitment orders.

16
 5 Do We Collect and Analyze Data to Measure the PMHC Against
the Four Key Outcomes?

Do we collect data to measure our success against the key outcomes of a PMHC, such as the four outlined in the introduction of
this framework? Is the data regularly reviewed? Do we assess performance against established goals? Is there a dedicated person
responsible for leading the data collection efforts? Are staff assigned to review the data and generate reports?

Why it matters
Data collection and analysis gives leaders in the law enforcement and behavioral health systems the ability to gauge the
effectiveness of their responses to people who have mental health needs. It also arms them with concrete data to present to
local offcials and the public at large to garner buy-in and support for the PMHC. Establishing baselines or benchmarks early
on is important to ensure PMHC progress can be tracked over time. For example, if the jurisdiction determines how many
people who have mental health needs come into contact with law enforcement offcers prior to the start of the PMHC, they can
see progress on this outcome the following year. Additionally, leaders can use data to determine whether current efforts and
procedures need modifcation or improvement, and if there are any gaps in community-based mental health services. Law
enforcement leaders may also use data to identify high-need populations that may require a more targeted approach. Data
also helps law enforcement leaders place individual instances or cases in context—as exemplary situations, typical examples,
or extreme outliers—so that response models can address the typical encounters, rather than respond to rare cases. Critical
to this work is the sharing of data across systems; PMHC partners can see which clients they have in common and measure
service utilization and dispositions.

What it looks like

✓ Tracking of specifc metrics: Jurisdictions establish clear guidelines about what information should be collected and
tracked. During planning, all partners working on the PMHC day-to-day (e.g., call takers and dispatchers, offcers on the
scene) agree on the defnition of a “mental health call for service” to establish the level of need in the community. The
tracking system also supports changing or re-coding a call based on information learned on the scene. Communities
also establish the key indicators of success for the PMHC that measure progress on the four key outcomes. Table 3 provides
examples of the types of data agencies can consider measuring to track the PMHC’s success against the four key outcomes.

TABLE 3. EXAMPLES OF PMHC DATA TO COLLECT TO MEASURE SUCCESS

Level of Need
Number of calls for service involving people who have mental health needs
Minimized Arrests
Number of arrests involving people who have mental health needs
Number of people who have mental health needs who have >1 arrest in last 12 months
Disposition/Resolution of Call (e.g., arrest, resolved at scene, transported for voluntary evaluation, detained for
involuntary evaluation, referral to mental health treatment)
Reduced Repeat Encounters
Number of repeat calls to the same location

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 Reduced Use of Force
Number of encounters with people who have mental health needs where force was used
Type of force used by offcers during encounters with people who have mental health needs
Injuries to offcers during encounters with people who have mental health needs
Administrative and Process Outcomes
Number of offcers receiving mental health and stabilization training
Number of offcers trained in selected PMHC response models
Percentage of shifts covered by trained offcers
Percentage of dispatchers trained on PMHC response models
Number of mental health-related calls receiving a response by a trained offcer

✓ Establish baseline data: The PMHC establishes baseline data on the number of mental health calls for service and on the
key outcomes. This baseline data is used as a comparison point at regular intervals to assess the PMHC’s progress.

✓ Process for ongoing data collection and tracking: The interagency workgroup takes steps to develop data collection
policies and procedures. In addition, the workgroup appoints a subcommittee or staff person to be responsible for collecting
and analyzing the available data and producing reports for review by the workgroup.

✓ Process for identifying individuals with frequent arrests and repeat encounters: The interagency work group
defnes what constitutes “frequent” or “repeat.” Arrest record data and mental health calls for service are disaggregated
and examined at the individual level to identify people that both the law enforcement agency and the behavioral health
partners frequently see. Since a small number of individuals often account for a large portion of arrests and encounters,
the workgroup regularly identifes these individuals and crafts targeted responses for how law enforcement and other
PMHC partners should handle their cases. The workgroup explores proactive case management and follow up as a strategy
to prevent repeat encounters.

✓ Data-sharing agreements: In addition to coordinating data collection, the interagency workgroup develops
mechanisms for how the partner agencies share data. These written formal agreements go beyond what information is
shared on the scene between offcers and mental health professionals to facilitate PMHC performance assessment. For
example, these data-sharing agreements answer questions such as what data points will be shared, who is collecting
this information, how it will be accessed (e.g., through a simple fle exchange between agencies, in a password protected
drive, etc.) and the frequency for sharing datasets. Jurisdictions follow federal, state, and local statutes on information
that may be shared among agencies.

✓ Data management system: The law enforcement agency has a mechanism to track its data, such as a dedicated database
or felds created in a computer aided dispatch system. The information system has the capability of tracking PMHC’s
success rates against the four key outcomes and other key indicators identifed by the interagency workgroup. This data
collection method or database can be queried, allowing for reports to be generated by dedicated staff members. It also
allows for the matching of data among agencies and systems to identify shared clients and to examine their service usage
and outcomes.

18
IN PRACTICE | Weaving Data Collection Practices into Daily Program
Operations, Los Angeles Police Department, CA
For the Los Angeles Police Department (LAPD) and its Mental Evaluation Unit (MEU), data collection is the
foundation supporting the full range of PMHC response models and initiatives they have implemented. Started
in 1993, LAPD’s Systemwide Mental Assessment Response Teams (SMART) was one of the frst police-mental
health co-responder programs to link people in crisis to appropriate mental health services and contribute to the
core data collection practices that the department has implemented.

The success of this program rests in how offcers are trained to collect and capture data when they respond to a
call for service and how that data is then used to inform the rest of the department and MEU. All 110 MEU offcers
and 50 mental health clinicians receive 40 hours of training to ensure that calls involving people who have mental
health needs are properly categorized, dispatched, and managed. The MEU Operations Guide is distributed to all
160 personnel assigned, providing them with a core understanding of the mission and operation. The MEU’s Triage
Desk collects data on all law enforcement contacts with people in mental health crisis, providing guidance and call
management. These contacts, including the circumstances of the call and disposition, are documented in a Mental
Evaluation Incident Report (MEIR). The MEIR is a structured behavioral health screening tool, data collection
instrument, and report that captures information such as a person’s behavior, thought processing, family and
personal relationships, religious affliations, and medication usage. SMART team offcers not only respond to feld
calls but staff the triage desk during assigned times throughout the year (e.g. for a month) to ensure that offcers
are familiar with what happens during the call taker process.

The department collects data that is used to inform the changes necessary to improve the daily operations of
their PMHC. The data collected by the triage desk, for example, is available to staff and leadership at all levels
to determine if changes need to be made to the mental health training curriculum that the department provides,
an increase in staff during certain shifts is needed, or if different content should be collected in the triage desk
assessments. Data is available “real time” to any offcer in the MEU to help manage a call or analyze crime
trends, and weekly reports are generated to provide the assistant chief with data analysis on the number of
calls the unit is handling, types of calls, location, and how they are resolved, among other things. Additionally,
dedicated data analysts present data to the chief during monthly COMPSTAT meetings to inform how the MEU
is operating overall, based on set performance metrics and if there are any trends that would inform staffng or
other resource allocations. Every three months, data is also presented to the Mental Health Crisis Response
Program Advisory Board to inform them of how the partnership is operating, with information regarding whether
a specifc hospital or crisis center has seen an increase or decrease in referrals, if there are more calls from a
particular community, or an increase in certain behaviors such as overdoses.

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19
 6 Do We Have a Formal and Ongoing Process for Reviewing and
Improving Performance?

Has the interagency workgroup appointed a person or subcommittee to report to leaders on the progress of the PMHC? How are
leaders staying informed of overall progress toward the stated outcome goals? Is there a process in place to adapt policies and
procedures when performance reviews show a need for improvement? Is there a plan to ensure the sustainability of the PMHC?

Why it matters
Regular, data-driven assessment of the PMHC is critical to ensure the collaboration achieves its goals. When law
enforcement leaders and their behavioral health partners use data to review the PMHC’s performance, it gives them the
ability to determine if expansions to the collaboration’s capacity are needed, with the decision based on data rather than
anecdotal information. A thorough review of the data gives executives and other leaders the ability to address issues they
might not have otherwise discovered. Sharing information about the PMHC’s progress and impact is essential for buy-in,
sustainability, and growth. The PMHC data analyses should be used to update leaders and to inform budget decisions and
recommendations for PMHC refnements. This review process must be transparent to the interagency workgroup, staff in
both agencies, and the results should be shared with the public. When these processes are in place, the agency can show
short-term success (e.g., the implementation of new policies or evidence-based practices) and/or long-term achievements
(e.g., minimizing arrests of people with mental health needs) to secure internal and external support. This continuous
monitoring of PMHC performance metrics provides leaders with the justifcation necessary to make the case for expanding
services and securing additional funding, which aid sustainability efforts.

What it looks like

✓ Routine data-driven performance assessments: The collaboration is periodically assessed based on its progress in
achieving the four key outcomes described in the introduction and any other agreed upon outcomes. The achievement
of short-term, more immediate accomplishments such as the implementation of new procedures, policies, or practices is
included in regular reports to the interagency workgroup. Community advocacy organizations representing people with
lived experience, along with their family members and peers, are provided information from these regular assessments
and reports and given an opportunity to provide feedback.

✓ Results-based refnements to policies and procedures: Data on the agreed-upon measures is analyzed regularly to
evaluate the PMHC’s progress and inform the refnement of programs, policies, and/or procedures. This data analysis also
helps inform the workgroup’s contemplation of any needed course corrections.

✓ Shared accountability among PMHC partners: Law enforcement leaders and their behavioral health partners share the
responsibility to continually review performance data to identify PMHC service capacity issues, such as low utilization rates
for a given service or if a service is consistently unavailable. Partners work together to address these issues. Procedures are
in place—which are outlined in interagency MOUs and/or information-sharing agreements—that designate key staff to
lead the performance review.

✓ Communication with external partners and leaders: Information is shared with county legislators, funders, and

20
 community-based organizations to gain buy-in and support of the collaboration. Sharing successes or challenges with
stakeholders leads to the PMHC receiving buy-in from the community and the additional support necessary for its growth.
The PMHC establishes regular mechanisms to receive feedback from the community on how to tackle challenges and
make improvements. Law enforcement leaders are responsive to the feedback of their offcers, community leaders, the
media, public offcials and other policymakers, and ensure that initiatives are refective of the public’s interests and
concerns.

✓ Additional PMHC capacity and long-term sustainability: Performance reviews reveal if PMHC response models or
community services must be scaled to satisfy the need in the community and to ensure that sustainable funding is in place
for various PMHC response models. During the planning phase, a long-term sustainability plan is developed to ensure the
interagency workgroup plans for obstacles that the PMHC might encounter in the future.

IN PRACTICE | Improving PMHC Performance Using Data Analysis,

Madison, WI
The Madison Police Department (MPD) has advanced their data analysis practices to understand PMHC performance
and to enhance their responses to people who have mental health needs. In 2016, with the University of Wisconsin,
MPD conducted a program evaluation of their mental health unit using data collected between 2013 and 2016. The
main fndings confrmed what they had suspected: mental health-related incidents doubled over this timeframe (as
a proportion of all calls for service), calls for people with co-occurring substance addictions also quickly grew, and
most importantly, a small number of people accounted for a disproportionate amount of mental health calls for service
(i.e., 3 percent of unique individuals accounted for 17 percent of their total mental health reports).

The evaluation also showed that when the Mental Health Unit provided follow-up services, the vast majority (over
80 percent) of people served generated no additional incident reports, which cut down on repeat encounters. With
evidence that follow-up services produced successful outcomes, MPD was positioned to enhance their follow-up
capacity, creating fve full-time mental health offcer (MHO) positions to help mitigate the increasing demands
on patrol offcers and to prevent repeated calls for service related to the same person. The MHOs were added to
support the existing Mental Health Liaison program already in place. In their work, the MHOs provide follow-up
support for people; coordinate with mental health providers, case managers, advocates, and families; and share
information with patrol offcers to develop response plans.

Based on these demonstrated successes and with this data in hand, the department expanded their in-house crisis
worker program to include three part-time crisis workers covering the equivalent of two full-time positions to further
support the program.

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21
 Acknowledgments
This framework was developed with the support of the U.S. Department of Justice’s Bureau of Justice Assistance (BJA), and in
particular, Associate Deputy Director Ruby Qazilbash and Policy Advisor Maria Fryer. The Council of State Governments (CSG)
Justice Center extends its appreciation for the dedication, guidance, and leadership they both offered during this project.
Many people provided guidance during the evolution of this project, drawing on their extensive experience and expertise in the felds
of law enforcement and mental health. They provided real world examples from which to draw, feedback on their frsthand and often
diffcult experiences, expertise around this emerging feld of research, and overall support and encouragement in too many areas
to count. Their critical advice, feedback, and willingness to provide input, multiple times, helped to create a strong and informed
publication. The people and organizations mentioned below were instrumental in this process; however, inclusion here does not equate
to endorsement of this publication or the positions presented within.
Representatives from law enforcement agencies in the nation’s 10 Law Enforcement-Mental Health Learning Sites provided extensive
feedback on a variety of content areas, attended focus groups, and reviewed multiple versions of the framework. They include:
Arlington (MA) Police Department; Gallia, Jackson, Meigs Counties (OH) Sheriffs’ Offces; Houston (TX) Police Department; Los
Angeles (CA) Police Department; Madison County (TN) Sheriff’s Offce; Madison (WI) Police Department; Portland (ME) Police
Department; Salt Lake City (UT) Police Department; Tucson (AZ) Police Department; and University of Florida Police Department.
Special thanks are due to the agencies below and the staff who provided expertise and reviewed multiple drafts, including:
• CIT International: Tom Von Hemert, President
• Major Cities Chiefs Police Association: Richard Myers, Executive Director
• The Meadows Mental Health Policy Institute: BJ Wagner, Senior Director of Smart Justice
• National Alliance on Mental Illness: Laura Usher, Senior Manager, Criminal Justice & Advocacy, Advocacy & Public Policy
• New York Presbyterian Hospital, NY: Dr. Dianna Dragatsi, Director, Comprehensive Psychiatric Emergency Room
• Police Foundation: Blake Norton, Senior Vice President and Rebecca Benson, Senior Policy Analyst
• Policy Research Associates: Dan Abreu, Senior Project Associate; Travis Parker, Senior Project Associate; and Chan
Noether, Program Area Director
A team of researchers, practitioners, and academics also provided insight into their work and helped the CSG Justice Center develop,
among many areas, the key outcomes presented in the framework. Those people include:
• Dr. Michael T. Compton, Department of Psychiatry, Columbia University College of Physicians & Surgeons, NY
• Dr. Gordon Crews, Professor of Criminal Justice & Criminology, School of Criminal Justice and Social Sciences, Tiffn
University, OH
• Detective Charles Dempsey, Offcer in Charge, Crisis Response Support Section, Mental Evaluation Unit, Admin-Training
Detail, Los Angeles Police Department, CA
• Dr. Alex Holsinger, Department of Criminal Justice & Criminology, University of Missouri – Kansas City, MO
• Polly Knape, Clinical Director, SUN Clinic, Tucson, AZ
• Dr. Melissa Morabito, School of Criminology and Justice Studies, University of Massachusetts – Lowell, MA
• Dr. Amy Watson, Jane Addams College of Social Work, University of Illinois at Chicago, IL
• Peter Winograd, Professor Emeritus, University of New Mexico School of Law, NM
Lastly, this document would not be possible without the tireless support of many CSG Justice Center staff: Director Megan Quattlebaum;
Sandra “Sandy” Jamet, program director, Behavioral Health Division; Cynthea Kimmelman-DeVries, deputy program director,
Behavioral Health Division; and Darby Baham, publications editor, to name a few. The authors would also like to thank former staff
who were instrumental in the creation of this document and provided either early drafts or core framing, including: Dr. Richard Cho,
Nicola Smith-Kea, Martha Plotkin, Dr. Fred Osher, Michael Thompson, and Anna Montoya.

22
Endnotes
1. Jennifer D. Wood, Amy C. Watson, and Anjali J. Fulambarker, “The ‘Gray Zone’ of Police Work During Mental Health Encounters: Findings from an
Observational Study in Chicago,” Police Quarterly 20, no. 1 (2017): 81-105, http://doi.org/10.1177/1098611116658875.

2. The “behavioral health” system refers to both mental health and substance addiction services (and providers). For the purposes of this framework, the
focus is solely on people who have mental health needs and the portion of the behavioral health system that serves this population. That said, given
the high rate of co-occurring substance addictions among this population, the framework also makes reference to connections to substance addiction
treatment for people who have co-occurring conditions.

3. CIT International (CITI), the organization that leads the proliferation of the Crisis Intervention Team model, similarly calls for law enforcement responses
to people with mental health needs to be implemented not as a training alone or small-scale programs, but as a comprehensive, community-wide
approach. See, Dr. Randolph Dupont, Major Sam Cochran, and Sarah Pillsbury, Crisis Intervention Team Core Elements, (Memphis, TN: The University
of Memphis, 2007), http://www.citinternational.org/resources/Pictures/CoreElements.pdf.
4. See, the “Police Mental Health Collaboration Toolkit,” U.S. Department of Justice, Bureau of Justice Assistance, https://pmhctoolkit.bja.gov.
5. Michael T. Compton et al., “A comprehensive review of extant research on Crisis Intervention Team (CIT) programs,” The Journal of the American
Academy of Psychiatry and the Law 36, no. 1 (2008): 47-55, http://jaapl.org/content/36/1/47.
6. Before leaders in a PMHC can determine if fewer repeat encounters are occurring, they frst must defne what constitutes a repeat encounter in their
community. For example, it could be defned as a person having a second mental health call in a six-month period or it could be defned as multiple calls
for service to the same location. Once properly defned, this target population can be prioritized for tailored interventions and treatment, and more
accurate benchmarks can be established to gauge the success of the PMHC. For general discussions on the importance of benchmarking, see, Gregory H.
Watson, Benchmarking Workbook: Adapting the Best Practices for Performance Improvement (Portland, Oregon: Productivity Press, 1992); and Theodore
H. Poister, Measuring Performance in Public and Nonproft Organizations (San Francisco, CA: Jossey-Bass, 2003).
7. Jennifer L. S. Teller et al., “Crisis intervention team training for police offcers responding to mental disturbance calls,” Psychiatric Services 57, no. 2
(2006): 232-237, https://doi.org/10.1176/appi.ps.57.2.232.
8. Research pertaining to the reduction of arrests after implementation of a PMHC is still in its infancy and in need of more review and evaluation. Studies
have shown a greater likelihood of diversion from the criminal justice system after a PMHC has been implemented, as well as fewer arrests in some
communities. See, Henry J. Steadman and Michelle Naples, “Assessing the effectiveness of jail diversion programs for persons with serious mental illness
and co-occurring substance use disorders,” Behavioral Sciences and the Law 23, no. 2 (2005): 163-170, https://doi.org/10.1002/bsl.640; and Henry J.
Steadman et al., “Comparing Outcomes of Major Models of Police Responses to Mental Health Emergencies,” Psychiatric Services 51, no. 5 (2000): 645-
649, https://ps.psychiatryonline.org/doi/abs/10.1176/appi.ps.51.5.645.
9. Portland has adapted elements of the CIT model to meet their local needs. As such, it may not represent fdelity to the CIT model.
10. While many law enforcement agencies are familiar with “CIT” as a specialized team or training program, the Crisis Intervention Team model is a
comprehensive, community-wide response in which a specialized team works within a larger agency context and partnership, consistent with the approach
outlined in this framework. See, Dr. Randolph Dupont, Major Sam Cochran, and Sarah Pillsbury, Crisis Intervention Team Core Elements (Memphis,
TN: The University of Memphis, 2007), http://www.citinternational.org/resources/Pictures/CoreElements.pdf.
11. Houston has adapted elements of the CIT model to meet their local needs. As such, it may not represent fdelity to the CIT model.
12. Michael T. Compton et al., “Use of force preferences and perceived effectiveness of actions among Crisis Intervention Team (CIT) police offcers and non-
CIT offcers in an escalating psychiatric crisis involving a subject with schizophrenia,” Schizophrenia Bulletin 37, no. 4 (2011): 737-45,
https://doi.org/10.1093/schbul/sbp146.
13. For more information on state training standards and requirements, see Martha Plotkin and Talia Peckerman, The Variability in Law Enforcement State
Standards: A 42-State Survey on Mental Health and Crisis De-escalation Training (New York: The CSG Justice Center, 2017),
https://csgjusticecenter.org/law-enforcement/publications/the-variability-in-law-enforcement-state-standards/.
14. These topics were compiled from nationally available CIT curricula, as well as feedback-generated conversations held with employees of the 10
national Law Enforcement-Mental Health learning sites. Each of these sites has adopted or customized their own curricula and suggested the most
common topics that they use.
15. These topics were compiled from nationally available CIT curricula, as well as feedback generated conversations held with employees of the 10
national Law Enforcement-Mental Health learning sites. Each of these sites has adopted or customized their own curricula and suggested the most
common topics that they use.
16. Missouri has built on the CIT model and adapted elements to meet their local needs. As such, it may not represent fdelity to the CIT model.
17. Sequential Intercept Mapping uses the Sequential Intercept Model to access the available resources, determine gaps in services, and plan for community
change within a jurisdiction. “These activities are best accomplished by a team of stakeholders that cross over multiple systems, including mental health,
substance use, law enforcement, pre-trial services, courts, jails, community corrections, housing, health, social services, people with lived experiences,
family members, and many others.” See, The Sequential Intercept Model, https://www.prainc.com/sim/; Dan Abreu et al., “Revising the paradigm for jail
diversion for people with mental and substance use disorders: Intercept 0,” Behavioral Sciences and the Law 35, no. 5-6 (2017): 380–395,
https://doi.org/10.1002/bsl.2300; Mark R. Munetz and Patricia Griffn, “Use of the Sequential Intercept Model as an Approach to Decriminalization of
People with Serious Mental Illness,” Psychiatric Services, no. 57 (2006): 544-549, DOI: 10.1176/ps.2006.57.4.544; and SAMHSA GAINS Center for Behavioral
Health and Justice Transformation, Developing a Comprehensive Plan for Mental Health & Criminal Justice Collaboration: The Sequential Intercept Model.

Police-Mental Health Collaborations: A Framework for Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs
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 The Council of State Governments Justice Center prepared this publication with support from the Bureau of Justice
Assistance (BJA), U.S. Department of Justice, under grant number 2016-MU-BX-K003. The opinions and fndings
in this document are those of the authors and do not necessarily represent the offcial position or policies of the U.S.
Department of Justice or the members of The Council of State Governments.

About BJA: The Bureau of Justice Assistance is a component of the Offce of Justice Programs and helps to make
American communities safer by strengthening the nation’s criminal justice system. Its grants, training and technical
assistance, and policy development services provide state, local, and tribal governments with the cutting edge
tools and best practices they need to reduce violent and drug-related crime, support law enforcement, and combat
victimization. Visit www.bja.gov for more information.

About the CSG Justice Center: The Council of State Governments (CSG) Justice Center is a national nonproft,
nonpartisan organization that combines the power of a membership association, representing state offcials in all
three branches of government, with policy and research expertise to develop strategies that increase public safety
and strengthen communities. For more about the CSG Justice Center, see www.csgjusticecenter.org.

The Council of State Governments Justice Center, New York, 10007

© 2018 by the Council of State Governments Justice Center
All rights reserved. Published 2018.

Cover and interior design by Mina Bellomy.

Bureau of Justice Assistance

U.S. Department of Justice

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