Editor's note: This article was edited to appear in the print edition of Modern Healthcare. Experience the multimedia version of this special report.
Back in 1991, the Houston Police Department began noticing a problem that continues to plague many law enforcement agencies today.
Beat officers were spending six to eight hours of their shifts working to get a detention order for emergency evaluation if they encountered someone on the street experiencing a psychotic episode.
The process included filling out a seven-page health form and having it signed by a judge and notarized before an officer could take a person to a mental health facility. The only facility available to take in such individuals had just 12 inpatient beds. If all the beds were filled, the officer had to stay with the detainee until one became available.
"Many of those officers had a very difficult time with the process in large part because they saw it as a mental health issue and not a law enforcement issue," said Rebecca Skillern, a training officer in the Houston Police Department's Mental Health Division.
So the department began looking into ways to streamline the process of moving people into psychiatric evaluation faster and getting police back to patrolling the streets sooner.
It began by partnering with Harris County's mental health authority on making the process quicker and expanding the number of available beds. The department also realized that officers needed better training on handling encounters with mentally ill individuals who were causing a disturbance. In 1999, the department launched its crisis intervention team training program, a community policing strategy that focuses on teaching officers techniques designed to de-escalate potentially volatile situations. The crisis intervention team approach was pioneered by the Memphis (Tenn.) Police Department in 1988 as a response to community calls for safer police encounters with those who had severe mental illness.
By 2001, the program had trained more than 200 Houston officers; now it has more than 2,000. The program now includes 40 hours of mandatory crisis intervention training for recruits at the police academy and eight hours of advanced intervention training for all officers, as well as additional opportunities for such education.
In 2005 the state mandated all Texas law enforcement officers to undergo a minimum of 16 hours of crisis intervention training.
Building on this success, the Houston Police Department in 2007 developed a mental health unit, expanding it to a division in 2013, and broadening the scope of work beyond crisis intervention training. The division includes crisis intervention response officers and teams, a homeless outreach team and a chronic consumer stabilization initiative for individuals who are repeatedly in need of police intervention. The division also has officers tasked with enforcing standards for boarding houses, which are often a low-cost housing option for the mentally ill.
In 2010, the Council of State Governments recognized the program as one of six in police departments across the country that other police agencies can visit to learn how to improve their response toward individuals with behavioral health disorders.
Skillern said these efforts improve safety for officers and community members by, among other things, reducing the likelihood that encounters involving the mentally ill will end up with police using deadly force.
"This is policing in the 21st century," Skillern said. "The reality of mental illness is that it's not going to go away, and especially in today's world where we're seeing that it's becoming much more significant."
Adults with severe mentally illness are involved in 1 in 10 of all police responses and at least 1 in 4 fatal police encounters, according to a 2015 report by the Treatment Advocacy Center.
Fewer than 3,000 of the nation's 18,000 state and local police departments have crisis intervention training programs, causing advocates to say much more work is needed to expand such programs. A big component among the more successful programs such as Houston's has been the collaboration between police and community mental health stakeholders.
"Training is great, but over the long term they are not going to have as much success if they go at it alone and don't coordinate much more closely with our mental health system," said Laura Usher, senior manager of criminal justice and advocacy for the National Alliance on Mental Illness.
