CIT training of police officers—and the broader CIT model—is being swiftly and broadly disseminated in law enforcement agencies across the United States, and local volunteer mental health professionals are typically involved in both the didactic and experiential aspects of the curriculum.4–7
A main goal of CIT training is to reduce force toward and injury of individuals with a serious mental illness like schizophrenia, in addition to being a form of pre-booking jail diversion. However, only one prior published study has examined use of force by CIT-trained officers.13
The present study yielded 3 key findings. First, although preferred actions escalated across the 3 scenarios in both groups, in an increasingly uncertain situation involving a psychotic and agitated subject (scenario 3), CIT-trained officers selected actions characterized by a lower use of physical force than non–CIT-trained officers. Results were unchanged when analyses were approached from a categorical perspective (ie, use of nonphysical actions vs physical force). Second, CIT-trained officers identified nonphysical actions as more effective than did non–CIT-trained officers, especially at scenario 3. Third, CIT-trained officers consistently perceived physical force measures as less effective than non–CIT-trained officers across all 3 scenarios. These findings provide the first empirical evidence that CIT-trained officers may be more likely to use nonphysical actions (less force), and to perceive them as more effective, than non–CIT-trained officers during interactions involving an agitated individual with a psychotic disorder. These survey-based findings should be followed by studies using other research designs.
Through the CIT curriculum, officers develop a deeper understanding of their own ability to positively impact the behavior of a person in crisis, moving toward de-escalation and away from use of force4
; the present findings suggest that CIT-based de-escalation training may achieve this goal. However, it should be noted that de-escalation training is only one aspect of the 40-h CIT curriculum; for example, officers receive several hours of teaching on symptoms and treatment options. Furthermore, officers entering CIT training may have more personal experience related to psychiatric conditions and their treatments (eg, a greater likelihood of having a family history of psychiatric treatment) and may generally represent a different type of officer in other respects (eg, psychological mindedness). Thus, the present findings are likely driven by baseline and exposure characteristics, the de-escalation training received, and other content of the CIT curriculum that increases knowledge and improves attitudes and skills.
That preferred actions reflected an increasing use of force in both groups from scenario 1 to scenario 3 was not surprising given that the suspect's use of force is obviously the most salient predictor of the officers’ use of force.22,23
However, these results indicate that CIT training may slow the advance toward forceful measures, ultimately lessening the risk of physical confrontation, injury, and perhaps even death. Ruiz and Miller9
suggested that at least 5 catalysts foster physical confrontations between officers and persons with mental illnesses: (1) fear on the part of persons with mental illnesses, which may be reasonable given that such encounters place them in the hands of unfamiliar police officers and result in taking them from their homes to a place that most do not want to go, (2) potential reluctance of persons in a mental health crisis to cooperate or comply with police orders, (3) fear due to the police uniform or the overpowering attitude of some officers, (4) lack of understanding and empathy by officers for the plight of persons with mental illnesses, and (5) fear that officers harbor themselves toward persons with mental illnesses, often related to perceptions of unpredictability or dangerousness. Each of these factors would be crucial to address in future studies of determinants of use of force in both CIT-trained and non–CIT-trained officers.
The CIT model, which combines specialized response capacity for psychiatric crises with partnerships that promote system change for enhancing psychiatric services, explicitly focuses on “issues such as the use of force and police response protocols, while requiring the mental health emergency system to respond in an efficient, user-friendly manner”.4(p339)
Yet, use of force has been largely neglected as a topic of research. Though studied in the criminal justice literature, discussions of use of force are nearly absent in the medical, mental health, and schizophrenia literature. This is despite the fact that physicians in emergency departments report managing police force–related injuries (eg, blunt trauma by fists or feet, handcuffs being too tight, hitting with night sticks or flashlights)24
and anecdotal but not empirically studied notions among mental health professionals that police encounters are often psychologically and physically traumatizing for persons with serious mental illnesses.
The International Association of Chiefs of Police11
use of force as “the application of an amount and/or frequency of force greater than that required to compel compliance from a willing or unwilling subject,” and the Bureau of Justice Statistics25
notes that the legal test of excessive force relates to “whether the police officer reasonably believed that such force was necessary to accomplish a legitimate police purpose.” In 1989, the U.S. Supreme Court, in Graham v. Connor
, held that “all claims that law enforcement officials have used excessive force—deadly or not—in the course of an arrest, investigatory stop, or other ‘seizure’ of a free citizen are properly analyzed under the Fourth Amendment's ‘objective reasonableness’ standard” as judged from the perspective of a reasonable officer on the scene, acknowledging that officers must often make split-second decisions about the amount of force necessary in a particular situation.26
Future research should examine occurrences of excessive use of force—an admittedly sensitive and controversial issue given prominent media reports in recent decades—in addition to preferred actions and perceived effectiveness. It has been noted that populations that have experienced police-perpetrated abuse may hesitate to summon police assistance, fearing that police officers might exacerbate the violence or further traumatize victims.27
It is reasonable to assume that individuals with serious mental illnesses may comprise one such particularly vulnerable population. Of note, the voice of these individuals remains largely unstudied, though some efforts are underway to remedy that shortage of research with persons with mental illnesses who have had interactions with law enforcement officers.28
The present findings should be interpreted in light of several methodological limitations. First and foremost, this study addressed use of force using a survey methodology, which obviously captures self-report rather than actual behavior. Having time to think through one's responses in a dispassionate manner could yield quite different preferred actions than would be seen in acute, crisis situations in which one's safety could be jeopardized. Data could not be collected on officers’ previous use of force. Although administrative data could be useful in addressing this research question, many agencies do not keep research-quality use of force information29
and others maintain reports only if there are injuries, potential injuries, or verbal complaints (of involved suspects or citizens) as a result of a confrontation. Due to the lack of appropriate administrative data, a vignette-based survey design was deemed most appropriate to begin examining both preferred actions and perceived effectiveness of force among police officers. Other approaches to addressing related research questions include the use of encounter forms or action/incident reports completed by officers after interactions13
or qualitative (observational) or ethnographic designs involving real-time follow-up with officers regarding encounters. Research also should focus on the persons with mental illnesses with whom they interact; this is suggested by one prior qualitative study documenting that such individuals sometimes experience encounters with police officers very negatively, including perceptions of unnecessary use of force, verbal abuse, and disrespect.28
Three other limitations are noteworthy. First, there may be important baseline differences between officers who elect or are assigned to CIT training and those who do not go through the training; those differences could account for the findings rather than the training per se. Regarding CIT officers in particular, prior research from this setting has revealed that approximately three-fourths report having volunteered for CIT training and about one-fourth report having been assigned to it30
; differences in officers’ characteristics related to these 2 modes of entry into CIT would be of interest for future research. Second, the Hawthorne effect or social desirability bias could have influenced responses. However, there is no obvious reason to suspect that a systematic bias (due to differential effects across the 2 groups) accounts for the findings. Third, generalizability may be limited given that all officers were recruited from a single police department in a large, metropolitan area. The culture within select law enforcement agencies (which is substantially influenced by leadership within the department) could influence the nature of findings, and community socioeconomic characteristics are associated with police behavior in terms of arrests, use of force, and police misconduct.31
The present results support the hypotheses that CIT-trained officers select a lower level of force in terms of their preferred actions in the context of an escalating situation and perceive greater effectiveness of nonphysical actions as well as lesser effectiveness of physical force. Given the fact that police officers frequently interact with persons with serious psychiatric signs and symptoms, additional research is clearly needed. In terms of broader considerations, although this line of research is primarily important for its clinical implications (eg, potentially reducing physical and emotional trauma to individuals with serious mental illnesses, possibly reducing arrest rates while facilitating referral to psychiatric services) and programmatic implications (eg, the need to proactively collect use of force data, justification for funding CIT implementation), broader social implications are fathomable. For example, clinicians’, advocates’, and schizophrenia researchers’ role in promoting social justice could be strengthened through partnerships with other diverse professions, including, but not limited to, public safety, law enforcement, and criminal justice.