Youth and mental health

Youth face significant delays — on average about 10 years — between the onset of signs and symptoms of mental disorders and actual intervention. Delaying access to needed mental health services can adversely affect the important developmental years of a young person's life, while linking youth to initial treatment is likely to reduce justice system involvement and school failure.

Research studies suggest that nearly 70 per cent of the two million youth arrested each year in the United States are touched by mental illnesses. The findings show that when young people with mental illnesses become involved in the juvenile justice system for minor, non-violent offences, they're often formally processed due to unmet mental health needs.

Arrest rates are particularly high among young people who drop out of high school and have unmet or undiagnosed mental health needs. Studies have shown that almost 75 per cent are arrested within five years of dropping out. With a disproportionate number of justice-involved youth meeting diagnostic criteria for mental disorders (70 per cent compared to 20 per cent among the general population), there's a great opportunity for intervention at the time when police officers respond to service calls involving youth.

In 2013, nearly 22,000 youth arrests occurred throughout the City of Chicago, Ill. Law enforcement officers play a critical role as first responders to mental health crises by diverting individuals with mental illnesses from the criminal justice system to community-based treatment providers.

To better prepare its officers to respond to this population's needs, the Chicago Police Department (CPD) implemented the Crisis Intervention Team for Youth (CIT-Y) training. In collaboration with the National Alliance on Mental Illness of Chicago, CPD developed a curriculum to instruct officers about the ways to identify the characteristics of crisis situations involving youth and assess risk of harm to self and others while applying corresponding de-escalation techniques.

Crisis Intervention Teams

Crisis Intervention Teams (CIT) use trained first responders of police-based crisis intervention alongside community, health care and advocacy partnerships. The adult CIT model originated in Memphis, Tenn., in 1988 and today there are approximately 2,500 CITs in the United States.

CPD began adult CIT training in 2004. In 2010, CPD sparked national interest by implementing the country's first 40-hour, five-day course that addresses the youth population: CIT for Youth training. CIT-Y was designed as an advanced course for officers who had already completed the adult CIT training. With a federal grant, the program held 16 CIT-Y training sessions from 2011 to 2014. More than 600 officers completed the course.

The CIT-Y model consists of a dynamic collaboration between law enforcement, school personnel, parents and community-based health providers. CIT-Y training and techniques are upheld through two department directives including one that established the CIT program and another that outlined the procedures for operation.

The CIT-Y training aims to do the following:

• Divert youth in crisis from the juvenile justice system to community-based treatment services.
• Advance officer knowledge of the signs and symptoms of youth mental illnesses.
• Increase the likelihood of safe interactions between police and the public during youth crises.
• Enhance the officer's ability to assess youth risk of harm to self and others, and apply corresponding crisis de-escalation techniques.
• Improve officer awareness of department directives that outline appropriate responses to crises.

To achieve the training objectives, CIT-Y staff developed 18 training modules. According to CIT-Y officers, the most helpful training modules were Community resource panel and Risk assessment and crisis de-escalation, while the least helpful module was Psychotropic medications, due to it being overly technical.

The Illinois Criminal Justice Information Authority conducted two evaluations of CIT-Y training in 2011 and 2012. This was done through a course evaluation survey, a curriculum test and focus groups held six months after the training.

The course evaluation survey gauged officer satisfaction with the training curriculum, the curriculum test measured officer's knowledge of youth mental health and appropriate responses to youth crisis calls, and the focus groups reported officer application of CIT-Y techniques in the field.

The year two evaluation surveyed non-CIT officers so that knowledge of youth mental health and appropriate responses to youth crises could be compared to the group of participants who received CIT-Y training. Evaluators identified the strengths of the program as well as the difficulties faced by officers when implementing CIT-Y techniques.

Implementation

The evaluation found that officers were very satisfied with the CIT-Y curriculum, rating it as very relevant and informative. CIT-Y training significantly improved officer knowledge of risk assessment, crisis de-escalation techniques and department protocols to use when responding to youth in crisis.

Additionally, CIT-Y officers reported that the training helped them identify the signs and symptoms of youth mental illnesses, and that youth presenting with such behaviours were less likely to be formally processed when handled by a trained officer.

One participant said, "I've been able to refer some parents to [a community hospital] instead of making it a criminal issue." Focus group participants reported using CIT-Y techniques almost daily.

The focus group interviews with CIT-Y officers also highlighted the challenges encountered when applying these techniques in the field. Officers noted that implementing CIT-Y techniques was difficult due to a lack of department support. Similarly, participants noted conflicting response styles between CIT-Y trained officers and untrained officers.

One participant reported, "My biggest problem is other officers who are not CIT-trained. We had a 14-year-old [with] a knife to the grandmother. [I] was able to talk him down, but officers want[ed] to Taser the kid and take him down. Other officers think he's a bad kid [with] a behaviour problem, but he was off his meds."

One barrier to implementing these techniques was a lack of department and public awareness and, as a result, emergency calls weren't properly connected to CIT-Y officers. Officers reported that dispatch didn't always assign crisis calls to trained officers, nor do citizens know the availability of officers trained in CIT-Y. In addition, officers stated that they experienced a lack of co-operation from school administrators, teachers and security officers. Officers stated that school personnel often challenged and disagreed with CIT-Y intervention techniques.

Future evaluation

The recommendations to improve officer application of CIT-Y techniques included increasing officer knowledge of signs and symptoms of youth mental illnesses and department support. Strategies to refresh trained officers about CIT-Y techniques and to develop rollcall training for district personnel were also recommended.

Evaluating CIT-Y continues with a focus on identifying the characteristics of crisis calls, assessing the prevalence of such calls, measuring the extent to which trained officers are linked to crisis calls, and exploring CPD responses to these calls and the impact of training.

The report, Evaluation of Chicago Police Department's Crisis Intervention Team for Youth training: Year 1, can be found at www.icjia.state.il.us/public/.

Publication of the report Evaluation of Chicago Police Department's Crisis Intervention Team for Youth training: Year 2, is anticipated in summer 2015 and will be made available online at ICJIA's website.