Better Mental Illness Outcomes through Community Collaboration: CIT (Ep. 26)

“Collaborative partnerships between law enforcement, mental health service providers, advocates, family members, and people with lived experience.” - Amy Watson

Sound good? That’s the foundation of the CIT Model.

“I could treat people like human beings” - Amy Watson

Police Activity is very much in the news these days, and response to mental health crises is often left in their hands.

Each of us has had experience with first responders, some trained in crisis intervention and some not. CIT Training is at least part of why our sons are alive (and not incarcerated) today.

Our guest today is Amy Watson, President of CIT (Crisis Intervention Team) International, a leader in promoting safe and humane responses to those experiencing a mental health crisis. She is also a professor at Helen Bader School of Social Welfare at University of Wisconsin-Milwaukee.

 CIT Basic Goals: 

• Improve Officer and Consumer Safety 
• Redirect Individuals with Mental Illness from the Judicial System to the Health Care System

We Talk About:

1. What is the CIT(Crisis Intervention Team)  program model? - and why do you personally do this work? -
2.  What does the research tell us about CIT?
3. What is CIT Training - what are the goals? Why the need?
4. What’s the cost? Who pays?
5. What’s the cost of NOT getting the training?
6. What do officers say who have had the training? Do they get pushback from other police officers?
7. How can a family member advocate for getting CIT training locally?

Links:

https://www.citinternational.org/

What is CIT?

https://vimeo.com/533695447

HBO Documentary “Ernie and Joe” - https://www.hbo.com/documentaries/ernie-and-joe

Transcript

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SPEAKER_02 0:01

Welcome to our podcast, Schizophrenia. Three moms in the trenches. From the place where schizophrenia and real life collide. East Coast, West Coast, Middle America. With Miriam Feltman, Mindy Gryling, and Randy Kaye. This is season two, episode one, but it's also our 26th episode. So welcome. And tonight we are going to talk about something that I think each of us have had experience with, and that is crisis intervention teams and the police. And guys, I haven't seen you in a while. So welcome back. Let's just do a quick one-minute update how everybody is with their families and their sons. Um, Mimi, why don't you go first?

SPEAKER_01 0:45

Well, things are going along well. Everybody is on a pretty even keel, nothing major one way or the other, which I always take as a win. Nick's doing very well with his exercise and diet. I mean, he's down like 50 pounds from before he went off. Oh, wow. So this is huge. And he actually said to me the other day, he says, you know, I feel better. I feel better about myself, and I feel better, like I don't feel like a big bloated person. And I mean, just that self-awareness is a huge thing. So that seems to be going well. We're still knee deep in the dental work, which I don't know if we're ever going to get fixed. Um, I had him, I was waiting, waiting patiently for this dental school to process his application so that we could afford these numerous root channels he needs. And um just found out today that they put it in the wrong box or something. So we're back to square one with that. Oh, for Pete's sake. These things are just, but you all know those frustrations. So it's kind of stuff. But all in all, everything's fine. Happy to see you guys again.

SPEAKER_02 1:58

That's great. I I posted something on Facebook this week just to give people hope because we also are in a good period. So we're grateful for every minute. If you're new to our podcast, I guess we should explain. We are three moms who are also authors and activists. We each have relatively grown sons with schizophrenia, each in sort of a different phase of recovery. And we're here to share that information and give hope. And by the way, celebrating 10,000 downloads of our podcast. We are in a place at the moment, this is 14 months after my son's breakdown, which resulted in his ninth hospitalization, five and a half months in the hospital. And at the moment, we're having a good, we're having a good day. And that's as far as I ever get. But Sunday is family visit day, and he used to have a a number of what I would call superstitions, what he would probably call beliefs, that he never shared, but little miracle things happened, like he allowed his sister to cook for him. Like he would always go, no, thank you. And we never know what's underneath those things. Honestly, a year ago, I thought that was never gonna happen. So I'm happy about that. It's a it's a hopeful, it's a hopeful day. Mindy.

SPEAKER_00 3:27

I saw that picture of your son and your grandchild or niece or whoever. And send it in an email, right? Oh my gosh, the smiles on their faces were so wonderful. It just made me practically cry. I was so happy. For us, Jim has had two medical problems in the last couple of weeks. He was in the hospital for three weeks or three weeks, three days with cellulitis. And, you know, most people say, oh my gosh, that's really painful, that's life-threatening, et cetera, et cetera. But we Grylings were celebrating. It was a small problem for us, you know, then compared to being in the psych ward where no one will talk to you. And would you believe no one signed a single release or asked us to? The doctor called me. We communicated, we could learn all about Jim's uh cellulitis, and nobody mentioned breathe the word of a medical release of information. Isn't that interesting?

SPEAKER_01 4:26

That is interesting. Yeah, he also had a big hump.

SPEAKER_00 4:29

Exactly. Physical problems where you can't communicate with doctors and everybody else. That's nothing for any of us sure.

SPEAKER_02 4:40

It's a world, it's a world of difference. So that's where we are at the moment. And if you're just starting on your journey with a child or a spouse or a parent or a sibling with schizophrenia, and you haven't reached a hopeful stage yet, we we hope that you will, and that's why this podcast exists. So I will share that when my son had his last breakdown, the way my local police department handled him caused us to write a thank you letter to everybody in the precinct. They could not have been better, and I would attribute that to good training. And they had empathy, they were endlessly patient with him. And every time that has happened in our numerous breakdowns, I have thanked my lucky stars for crisis intervention team training. I believe that our local police have had it, have been trained in some way. And so I thought we would explore that tonight. Uh, you know, police activity is very much in the news these days, and response to mental health crises is often left in their hands, where right now it is the police. They're the frontline responders. And each of us has had experience with police officers trained in crisis, and maybe that's why our sons are alive and not incarcerated today. So I'm gonna bring on our guest uh in a moment. Her name is Amy Watson. She is a professor at the Helen Bader School of Social Welfare at the University of Wisconsin, Milwaukee. She's also president of CIT International, CIT Standing for Crisis Intervention Team. Amy Watson, come on in, join us. Hi, good evening. Good evening. Thanks so much for joining us today. We're just thrilled to have you. I had the pleasure of speaking at CIT International about, I want to say about four or five years ago, back when we met in person and shared a bit of our experience. And I will also share with you that I was attending a LEAP training uh with Dr. Amador LEAP being a process for communicating with your loved one. And we had CIT trained police officers in our group, and they shared with me that they wanted to know even more because it was so helpful, but that other members of their police force called them the touchy-feely guys and weren't always that supportive. So we'll we'll get into that. I want to start by asking you two things really. I want to know your story, why you personally do this work, and then maybe you can just morph into what is the CIT program model?

SPEAKER_03 7:32

Sure. So why I'm drawn to this work is complicated to some extent, but I do identify as someone with lived experience of mental illness, had significant difficulties, particularly as a young person, although my pathways have been extremely privileged in terms of access to resources, good care. So that's something that I brought, you know, kind of forward as I started my professional career. And I was initially out of college, I was a probation officer for about seven years, serving on a team that specialized in working with probation clients with serious mental illness. And there, I mean, one of the things that I felt that I brought to that work was, and I didn't fully recognize my own lived experience in it, but that one thing I could offer to people, even though service systems were fragmented and they had a lot of challenges, I could treat people like human beings. And that's something that oftentimes, particularly people with serious mental illness going through the criminal legal system, don't get much of, which is really unfortunate. But I also, what I what I saw there is I had a lot of clients, often young male clients who were early in their illness, that had repeated contacts with the police, and not necessarily because they were involved in anything criminal, but somehow because of the contact, they ended up with a disorderly conduct, obstructing justice, battery to a police officer charge. And this was a repeated cycle, then court dates were missed, warrants were issued, and it kept going. And that's really where I got interested in this intersection and went back to graduate school and I started doing research on police encounters with people with serious mental illness. And Chicago, I was in Chicago at the time, and they were starting to look at implementing CIT. So I was part of that process and got some opportunities to get involved in CIT, but also to do research on CIT. And that's really the work I've been doing for almost two decades now.

SPEAKER_02 9:30

Wow. So what is the program model? If you could sort of sum it up and then we have more questions. But sure.

SPEAKER_03 9:37

So the the model most people are know of the CIT training, which is a 40-hour training. According to the model, it's for officers that self-select into the training. So they may be particularly have interested in developing their skills for responding to mental health crisis calls. The training involves going through signs and symptoms, different medications, de-escalation skills. There's a lot of time spent on talking to family members, people with lived experience, and developing empathy through just that interaction with people and getting a better understanding. A lot of time spent learning the local community resources so that officers know how to connect people to care. And then they also do a fair amount of scenario-based practice of the skills that they're learning. So it's it's a really packed week with a lot of information and a lot of opportunity to interact with people and to practice skills. So that's that's a piece of the model. But the larger sort of foundation of the model really is collaborative partnerships between law enforcement, mental health service providers, advocates, family members, and people with lived experience that really work together. They look at the services available in the community and identify gaps and opportunities to build that system, you know, and hopefully so that there's more access for people before they go into crisis, but also that the system's able to respond when there is a crisis. And if officers are part of that response, that they're well prepared to do that safely and effectively. So really the training by itself is important, but it really has to be supported by those partnerships. That's really, really where you see the most effect.

SPEAKER_02 11:26

Mimi, you want to share anything about your experience with police or yeah, you know, I um the one story that I tell often was the scariest one.

SPEAKER_01 11:38

And uh Nick had been having it turned out he had taken some street drugs and he was in very bad psychosis, and he happened to be at the office of the place that does his in-home care. So she called me and said something's really wrong with him. And I said, please don't do anything till I get there. And I'm 40 minutes away, but I'm so afraid of anybody calling the police because of all the stories that we've all heard. And so I um I drove madly there, and as soon as I got there, I could see he was in real bad shape. So we called. And this is before this is after I lived in LA. This is up here in Washington, where I live in a small town. So I was even more afraid because I knew in LA, at least the policeman by and large had the CIT training that had been my experience. And so the ambulance, the police arrived first. And you know, he comes out with his gun and he's, you know, coming up to Nick, and I'm terrified what's gonna happen. And I tried to take him aside and tell him what the circumstances were, and that Nick has schizophrenia, and that he's clearly psychotic, but he's never been violent and he's not a threat. And I didn't get two, three words into it till the policeman said to me, Tell it to the paramedics, don't tell it to me. And I said to him, Well, you're the guy with the gun, so I'm gonna tell it to you, and I'm also gonna stand between you and my son. And he wasn't real pleased with that, and um didn't really talk to me anymore and was kind of hostile. And when the paramedics came, I mean, it was it devolved and it was really bad. But what strikes me about that experience is not only the indication of how we have to be in fear of the police who were there supposed to help us, but also that I am, you know, a middle-class white woman in America. So I could say to him, Well, I'm gonna put myself between you and my son, because I knew damn well he wasn't gonna shoot me. If I'd been black or brown, I think it would have been a different story. And uh, I know it could have been a different story, and we see those stories on the news all the time. So to me, it's an indicator of how flawed the system is in terms of police response, but also how much worse it is for people of color, and that it's time to just acknowledge that and started correcting it because it's really bad.

SPEAKER_02 14:20

Okay, so and that will morph us into another area. It's definitely worth talking about, and we'll we'll leave that statement as it is because it's true, it's absolutely true. So I have a question then, too.

SPEAKER_01 14:35

My question is what does the research tell us about CIT?

SPEAKER_03 14:40

So there's a pretty good body of research now, and so I would say CIT is evidence-based for improving officers' knowledge, their attitudes, their self-efficacy for responding to mental health crisis and their endorsement of de-escalation skills. We also have pretty strong evidence that CIT um increases um linkages to care. So um in communities that have CIT programs and CIT trained officers, officers are doing more to, when they respond, to get people linked to care, be it a transport, be it um accessing a mobile crisis team or some other type of linkage. The studies that some of them I've done and that my colleagues have done have found that CIT trained officers are more likely to make an effort to make those linkages for people. The data on arrests and use of force are a little murkier, partially because they're relatively low frequency events statistically. Unfortunately, you know, when they happen, they seem very big, but it's a little bit harder to kind of identify if we're having a significant effect. But there are some studies that have found reductions in arrest, you know, following CIT implementation. And one of the studies I did in Chicago, we found that CIT officers were less likely to use force with more resistant people that were experiencing crisis. So we have some signals on arrest and use of force, but we just don't have as much evidence at this point on those two outcomes.

SPEAKER_00 16:14

And I will say, welcome to as a neighboring state, I'm from Minnesota. And even though the international president, I know you're in Wisconsin. And so Packers, my husband would say, because he's from Green Bay, heading to the Packer game this weekend. So I'm so so glad you're here. And so, my personal stories before I get to my question, I actually have three short ones. One, I'm interested that you said use of force you think is less based on the research that you do have with CIT trained officers. And the only time our son has ever had force used against him was before our local police had training. And at that time, um, you know, they tackled him, hog tied him down to the stretcher in the ambulance and shrieked at me to stay back, stay back, stay back, you know, to the point where I was uh registered a complaint with our police chief afterwards and our mayor. And then, you know, it wasn't too long after that that now the police officers in my local community do get training. They don't get um CIT training necessarily because in Minnesota our law says 16 hours of training versus the 40, I think it is for official gold standard CIT training. So I'd be interested in your comment on that. But the next episode, I think, might be a demonstration of why maybe 16 hours isn't enough. Because we were at our wits' end with our son. And by the way, every time we call the police, his illicit drug use is always involved. And we take our hearts in our throat as well, because like Mimi said, even though I'm middle class and white, we still fear there are plenty of examples of people with mental illness of all colors being shot. It's definitely heightened with people of color. And as I'm well aware of being from Minnesota, where George Floyd was murdered. But um, so this time the officers have had training. And we were at our wits end because I called the crisis intervention team, and they, once they heard the situation over the phone, said they couldn't come out. It wasn't he wasn't dangerous enough to himself or others. And I, his regular mental health workers said they could do nothing because he has his own choice to make about the lifestyle he's living. And but both of the two advised me to call the police if he if things should escalate. And so I described the situation. They said, yes, call the police. What the situation was was he was, he and I were sitting in a coffee shop, but because he was using drugs and he had breakthrough symptoms, he was paranoid about other patrons in the coffee shop. So he thought they were saying bad things about him, they were trashing him. So he was turning to each one as they said something bad about him and was spitting in their direction. He wasn't doing it uh very forcefully, so I don't think anybody knew he was doing that, but I could tell he was doing that. So I and I couldn't get him out of the coffee shop. And I thought if one person looks at him or says anything out loud that I could hear, it could escalate. So I called the police as everybody recommended that I do. And these trained police came out and said they they were very good about the escalating. They pulled Jim aside and said, you know, what is your diagnosis, sir? And um he said schizoaffective disorder. And then the police officer turned to me and said, Oh, well, with that diagnosis, you know, hearing voices and reacting to them um is that's that's how he he is all the time, ma'am. So so there's so we are just gonna leave you with him. And um, so that was a time when I thought a little bit of training wasn't enough because here I am, the mother saying, My son is very sick. Everybody that works with him in the mental health world knows he's sick. They're telling me to do something to call you. But they just thought the police officer responding thought that Jim was always that way because of his diagnosis, you know, and he's not, he would not normally be spitting on people or being paranoid uh in the coffee shop. But they left me then with him. And then this last time I just want to mention briefly a positive encounter. We um Jim was very out of control in our house, and I called the police, and they, I think, could have easily taken him to jail, or I wanted them to take him to the hospital, but they so succeeded in de-escalating the situation skillfully and wonderfully that Jim totally calmed down and they separated him from me and took him back home again. And then nothing came of it. Well, we had more episodes because he continued to use drugs and he wasn't doing well, but that time um everything was smooth as glass when they left. So those are my three examples, and I would like you to comment on the 16 hours versus the 40. But also my questions are um, what is the magnitude of the need for trained officers? And what are some of the specific goals or ends that you've seen by having officers trained?

SPEAKER_03 21:51

Sure. So I'll start a little bit addressing the question about 16 hours, a little bit by going back to the original Memphis CIT model. Was really designed so that it wasn't necessarily the 40-hour training for all officers. The idea was to identify officers that would be particularly good at responding to mental health calls that had an interest in being CIT officers and they would go through the training. And then when mental health-related calls were identified, that those officers would be dispatched, or, you know, if another officer could request them. So you had these officers that became specialists, and it wasn't just an officer that sat through a 40-hour training. It was an officer that this was part became part of their professional identity. That doesn't mean that all officers don't need some training. They need some training in their pre-service academy. They need in-service training on a regular basis that covers de-escalation and some mental health components as well. It's hard to say whether 16 hours is enough. It certainly wouldn't be enough if it's just a one-shot deal. It's something that needs to be reinforced. And we're starting to see more states put in requirements for, you know, a certain number of in-service hours devoted to mental health crisis response every three years. So people are starting to get the idea that it needs to be offered multiple times. So I think that's important. The other thing is, you know, if you have the officers that take on this kind of specialist role, they become champions in their agency. And you start to see a shift in the culture of the agency in terms of how they look at how they should be responding to mental health-related calls and kind of what the norm should be. And that can be a really important piece too. So maybe not every officer is a CIT officer, but they have an idea of that this is actually something that, you know, it's valuable, it's an expectation, that I provide a good response. And if I identify a mental health-related call and can access a CIT officer to assist with it, that's what I should do. So that's an important piece of the model that you know many times people just think we'll just throw all the officers in the 40 hours. But that doesn't necessarily get the outcome that you want because not all of those officers will fully engage in the content.

SPEAKER_00 24:15

Thank you. And Minnesota does have every three years certain trainings that have to be repeated. So we're one of those states. So excellent. And then the goals or the need, the magnitude of the need.

SPEAKER_03 24:28

I think the magnitude of the need is really, I mean, it's pretty substantial. Um, we know that police agencies are being called on to respond to to behavioral health crises at an increasing rate, um, and particularly um it's more rapidly increasing with the pandemic. Um we have uh a shortage of mental health service providers or they're at capacity or over capacity. Um, and we also have people that have stresses that they haven't dealt with before. Um so we've really seen increases there, and and police agencies that I've talked to have said that yeah, we're really seeing an uptick in the number of mental health calls. And while it's certainly, I mean, it's the estimates of what percentage of the calls for service that they respond to vary because um we don't have good data on it. But it's known that it's something that takes up significant time, and it's also these are situations that have a great potential to be productive interactions that actually help people and help families, or to be really destructive interventions. So I think that's an important piece to recognize as well. And the goals of CIT are really to use those partnerships across agencies and stakeholders to do a couple of things. One is to really prepare a set of a cohort of officers to provide effective, compassionate response when it's needed, but it's also to work together across stakeholders to build those systems that are more responsive, you know, so that you can get mobile crisis out there even if you haven't already assessed that the person's in danger to self or others, because crisis starts before you reach that point. So to be able to access assistance earlier in a crisis and not having to wait until you're finally at the point where, you know, okay, I'll call police because I don't know what else to do.

SPEAKER_00 26:21

The officers sometimes get frustrated, as families do, when there isn't there aren't enough services to hook people up to when you're intervening in a crisis and then you want to help, you want to hand off to somebody who's a mental health trained person. And then when there's such a long waiting list at times, it must be frustrating for officers, like it is for families.

SPEAKER_03 26:43

Yeah. Yeah, I've talked to a lot of officers that talk about that because you know they really want to be able to provide an effective response. And they go to home from work feeling more satisfied with their work if they really have been able to use tools and help people. And they're really frustrated. I mean, I know I've talked to officers that say, you know, we can get somebody to the emergency room or or to a crisis triage center, but sometimes we see them walking out the door before we leave the parking lot without any effective linkage to care. And so they are frustrated.

SPEAKER_02 27:15

Yeah, join the club. Absolutely. You know, we have spoken a lot in our previous episodes about the continuum of care and what happens after release from the hospital. And this is like continuum of care and teamwork before hospitalization or before the crisis, and it is so important. So a few rapid fire questions, because I'm just curious. Is uh CIT in every state?

SPEAKER_03 27:39

I believe there are CIT programs in every state. We have estimates that there's probably around 3,000 CIT programs uh across the country and a few outside of the US, but it's hard to put an exact number on it. But yes, there are there are CIT programs, I think, in every state at this point.

SPEAKER_02 27:59

So that's great. So I am the uh chief of police in my town, let's say. What's this gonna cost me? Who pays for it? Why should I send my office? Well, I know why I should. What would stand in the way of me sending all my officers for this training financially?

SPEAKER_03 28:17

So a police chief might be looking at what does it cost? And oftentimes when communities start a CIT program, you have this group that comes together. It's you have mental health providers, law enforcement, oftentimes local NAMI groups or other advocacy groups. Sometimes you have peer provider organizations that come together to develop and implement the training. And oftentimes there's a lot of in-kind work that's going on. So, you know, you may have clinicians that do some of the training that are just covered by their agency. It doesn't cost the police agency any. You may have agencies that are willing to make space available to do the training as well. So then your main cost really is the officer time and basically backfill for the time that they're off the street. So that oftentimes is a cost. And in what we've seen, some states you have funding for CIT programs that come through their uh Department of Health Services. In Illinois, where I live most of my life, the funding comes through the Illinois Law Enforcement Training and Standards Board that funds some of the training. You also may have some local funding, and I've seen asset forfeiture money being used to fund some of the training. But the typical costs are space, minimal materials. Sometimes there's honoraria for the content experts that come in and provide some of the training, and then there's the the officer time to do that. In an established CIT program, there's usually at least one person who is the program coordinator. Oftentimes there's multiple coordinators. Um you have a law enforcement one, an advocacy, and a mental health one. And so that could be a position that's paid just to have that role, or it could be that you have people that that's part of their job at whatever agency they're from that do that. So as a program gets more established, that coordination piece can be really important. So that's a cost. It may be an in-kind cost or a specific cost to the program.

SPEAKER_02 30:17

A lot of coordinating. So so, and I imagine some police, I got to do a ride-through, a ride-along once with a police officer who was CIT trained. And we actually went to a family the day after the crisis to make sure that they had resources. And I was like, You do this? Because that never happened to me. That has never happened to me. There's never been any. So I don't, you know, I don't know if it's trickle-down training, like they send three officers and they come and share with the guy. I don't know. But on the flip side, what would you say? And I guess there's no easy answer to this, so maybe just a couple of sentences. What would what's the cost of not getting this kind of training or not having this team in place?

SPEAKER_03 31:02

Um, I think there's there's multiple costs. I mean, one is just bad outcomes of mental health crisis encounters that have, you know, significant costs to communities. I mean, it impacts the person who's in crisis. They, you know, may or end up arrested when uh connection to services might be a much more effective approach for everybody. Um, you may have someone who or just not connected to anything. You could have uses of force and injuries and lawsuits. So there's cost to those police agencies as well. But then just the cost of having bad encounters for the police agency, encounters that are experienced negatively by the community, don't help them with their relationship with the community or their legitimacy in the community. So anything that police agencies, when they can do things that can really improve their response and help them be more effective, that has a currency for legitimacy, which is really important to policing right now. You know, with all of the tensions and all of the concerns across the country, taking steps to make sure that they're providing as effective a response to people is really important. So, you know, some chiefs will see it as protection from liability and lawsuits, which it can be, but other chiefs really see it as a way of improving their agency's ability to provide service to the community. And I think it's really important there. The other costs are, I mean, I think officers that feel like they don't have the tools to do their job effectively will experience more burnout and more dissatisfaction with the job. So implementing programs that help them do their job better actually, you know, can have an important impact there as well.

SPEAKER_01 32:45

I'm curious, what do the officers say who have had the training? Like, do they get pushback from other officers? Um, Randy said something about they said, Oh, you're the touchy-feely, coachy-feely guy.

SPEAKER_03 32:58

Um, well, when I've talked to officers that have had the training, typically what they tell me it's the best training I've ever had since I've been on the force. I had one officer tell me it's the only training I've ever stayed awake for the entire training for. And they'll tell you the parts that you like. I talked to an officer that, you know, maybe did the training five years ago, and what they remember is the people that come and share their lived experience and the family members. That's what really makes it gel for them. And I have, I mean, I've heard officers talk about how, you know, they get a little bit of razzing from other officers that, you know, they're in the hug a thug program or something like that. But I've also heard, you know, I've done write-alongs with non-CIT officers, and they'll say, Oh, they're really happy that the the agency has a CIT program because I had an officer tell me, he's like, you know, if I get to a call and it turns out it's a mental health crisis, I can call a CIT officer to come and assist me in managing it. And that was something that he felt was really useful and helped him do his job better. So I think you have different reactions, and um I think over time, as CIT programs can help change agency cultures, you see less of the razzing and more of the appreciation of there's this resource that I can utilize too when I'm doing my job. And I think it's more appreciated.

SPEAKER_00 34:19

So we are all very fierce advocates, mothers, and advocates to improve the mental health system, Mimi and Randy and I, and we've exhibited that in some of our earlier programs. I mentioned that I talked to our chief in my local city, and later we got officers trained. I have a walkie partner who's on the city council in a neighboring city, and I constantly talk to her about all the things going on with our son, including encounters with the police and so forth. In fact, she's in my book that I wrote, Fix What You Can. But she's also on the city council in a city of Maplewood here in Minnesota, and they have trained officers, they also have a couple of social workers that go out at different times with officers. They have invite involved their fire departments. So, for those kind of visits that you mentioned, that we all think would be utopia and have never experienced the kind where they come later and check on people and they're proactive. The firefighters and the police officers do that in this city. So that is like incredible. And I feel like I, by sharing my story every Friday with this walking friend of mine, have helped that other city. I wish I was walking with a council member from my city. But our listeners for this program are often starting out new in the mental health world, and they have young family members who are just starting with schizophrenia. So, with all your experience internationally and around the country, could you give us some steps that the average family could take to advocate with their city to get CIT training for their police officers?

SPEAKER_03 36:10

Absolutely. And I think actually family members are the most effective advocates here. So I think some of it is, you know, making contact with somebody at your police agency. And as a member of the community, you can request those those meetings with, you know, if it's not the chief, somebody higher up and to sit down and tell your story. Um, also connecting with other families and going together so that there's the strength in numbers in doing that. I've talked to people that have said, you know, I've tried reaching out to my police department repeatedly and haven't had much luck. So it could also be useful to start connecting with mental health providers in the community because there may be some people, you know, at your accounting mental health agency that could become champions for you that might have some ability to make inroads with the police department, with other partners. So it is really working those relationships. But as a family member in a community, I mean, one, as a member of the community, you have the right to talk to the people that are making decisions, but also as a family member, you have the ability to really bring in a powerful story. So I think by starting there and starting to work and talk to people, develop relationships and networking until you can get to the people that can kind of get you in. Is I mean, that's what I've seen so many different places as where things have started. And really starting to build a group of people that will work together on it. Because I mean, so many families include members that struggle with mental health issues. So it's not like you have to look that hard to find other people that you can share some experience with. And so really working those relationships and building that group and kind of networking and then figuring out those kind of levers where you can get in in front of the people that can make the decisions.

SPEAKER_00 38:05

Thank you for those. I think those are absolutely wise words. And one thing I did in my community, I co-chaired a committee through the League of Women Voters, where we studied the police. And we actually had the George Floyd murder in Minneapolis, but we had Philandro Castile, who was also murdered just during a regular traffic stop by an officer who panicked and shot him. And um, that was really tragic too. That was one of our cities, and our League of Women Voters study came out actually two weeks before Philandro Castile was killed. So we had just been to that very um city council with our report, and we were asking for more training, more data for you know how many traffic stops and what color were the people that were stopped, and what were the results? And so all most police um departments in this area collect data. And then because they're collecting data, the ones that have been the best at it, they've been getting grants from the county for social workers to go out with the police. And that's my last question for you is do you does your organization have any position on social workers going out with the police? NAMI, Minnesota, National Alliance on Mental Illness, isn't a great fan of that because they think that this police should be hooking people up with other services. As a family member, and I'm president of my local NAMI affiliate. I actually like the idea of a police officer's being accompanied by social workers. So does your organization have any official position and what's your personal uh position?

SPEAKER_03 39:47

So we have recently we put out kind of a statement kind of explaining why we are not a fan of embedded co-response. Um, and that would be putting the social worker in the police car. We do think there's great value in co-response. There are situations where having both a clinician and an officer at the scene can be useful. Um, but our concern about embedding the social worker in the police car is that means that the social worker is not able to ever respond without the officer. So, in order to get the social worker, you you always get the officer. And what we've seen in some programs that do this, the social worker will start looking tactical. So I have some pictures that people have sent me that you can't tell who's the police officer and who's the social worker. And that social worker, their clinical interaction ends up being dictated by the police agencies' policies and procedures because that's what they're working with. So CIT International, um, what we really promote and encourage communities to do is that certainly develop those partnerships so that they can co-respond when needed, um, but also really work to develop independent responses that don't require police unless there's a specific reason that a police officer needs to be there. And then you have to have those relationships. So when both show up on scene, they can work together to provide a good response. So that's where our position is. Um, not, I mean, certainly many communities are, you know, putting a social worker in a police car and finding it useful. We'd like to see that more as a step towards developing more and more on the side that doesn't always require police, but but engages police when it's necessary and has the ability to effectively partner.

SPEAKER_00 41:38

That is an incredible distinction that I did not know before. So that's my learning for the night. I always learn something myself on this program. So thank you very much, Amy.

SPEAKER_02 41:49

Yeah, thank you.

SPEAKER_00 41:50

Mimi, you had one more thing to add.

SPEAKER_02 41:51

We are in our final moments.

SPEAKER_01 41:54

Okay. There, um, I don't know if you're aware of this, Amy, but there's a HBO documentary called uh Ernie and Joe Crisis Comps. And there it's it's pretty accessible, just go online. And it's to it's a CIT program in San Antonio, and it's just such a wonderful depiction of this, and it's something that I think people who don't know a lot about it should watch because it it I think it'll open a lot of eyes.

SPEAKER_03 42:22

Yeah, it does a really nice job sort of humanizing the officers and and showing just, I mean, they really are working hard to provide a good response, as well as showing the importance of making sure we have officers that are prepared to respond.

SPEAKER_02 42:38

Thank you. And is it true? Because we're getting to our final words, but if a family member is calling the police in, I would imagine it is helpful to give information on the phone that might be helpful. Like my son has a diagnosis of such, like, let them know the diagnosis, let them know he's not violent, because you don't know if the officer you're getting is part of crisis intervention team or not. You can ask for, can they ask for a CIT member? Or just whoever comes, comes. I mean, just give them information so that they don't come in there with their like Mimi had with their guns out. Right. Family member, is there any other tips you can give what the family member can tell the police to help them assess the situation accurately before they walk in?

SPEAKER_03 43:27

Sure. And you know, certainly having sort of a crisis plan and um kind of having the information that you'd want to provide to your the call taker about, you know, that would be important. And and certainly it depends on where you are. You know, I know in Chicago as part of projects where we were trying to get information out to the community saying that if it is a mental health crisis and you're calling 911, ask for a CIT officer. Um it's kind of a shortcut to the call taker actually identifying this as a CIT call because you can specifically ask for it. And like in Portland, Oregon, if a caller specifically asks for um it's an e-CIT officer there, that's one of the criteria for dispatching them. You know, just that in itself. So, you know, kind of knowing what's available in your community, but certainly asking if that's available and providing information that can be really useful. And also having family members a little bit educated too on what to expect when police arrive, you know, kind of what some are some of the things that police do that they have to do for safety can be useful as well. And, you know, and hopefully, luckily, you know, if officers have been through a good CIT program, they've had some opportunity to talk to family members too and have some understanding of what the experience is for a family member in that moment and some compassion for it. I think oftentimes family members are sort of forgotten in terms of needing support as well, because it's not just a crisis for the person that's being called on, it's a crisis for the entire family.

SPEAKER_02 45:00

Um we definitely know that. Here, here. And you know, that if you need book recommendations for these trainings, you've got fix what you can. He came in with it, been behind his voices. Lastly, Amy, where can people get in touch with you for more information? I know there's a there's a video on your website. Tell us where they can go to learn more. Sure.

SPEAKER_03 45:23

So at citational.org, that's our website, and we have some information there. There's a brief video about CIT. Um, we also have a CIT best practice implementation guide that can be downloaded for free. You can also order a hard copy, but that's not free because it costs us something. But but there, that really goes through a lot of information about CIT. So that's pretty accessible. We also have a number of different programs as well. So our website has a lot of information. You can email admin at CIT International if you have questions about CIT. I get all those emails, as does our executive director. So people send things and we direct them to the people that are most likely to be able to answer questions. So that's another way of getting in touch.

SPEAKER_02 46:08

Awesome. Well, I personally thank you so much for the decades of work that you're doing. And it does my heart good to know that you find family stories valuable as well. Um, Mimi, Mindy, anything to add other than thank you? I thank you.

SPEAKER_00 46:25

And I will add my thank you. And Amy, uh, to me, you are you embody the persona and the demeanor that we would all want in a police officer coming to our door. So thank you. Thank you.

SPEAKER_02 46:41

Thank you for joining us today. Thank you.

SPEAKER_03 46:45

It's been a pleasure.

SPEAKER_02 46:46

Hey, thanks for joining us for this episode of Schizophrenia Three Moms in the Trenches with Randy Kay, Mindy Gryling, and Miriam Feldman. To get in touch with us or to learn more about our books, please visit our websites at MiriamHyfenfeldman.com, MindyGryling.com, or randyk.com.