3
Sincethe1970s,personswithmentalillness(hereafter,“PMI”)havebeenhandledincreasinglybythecriminal
justicesystem,aprocessreferredtoasthe“criminalizationofmentally-disorderedbehavior.”Manysuspect
that deinstitutionalization contributed to increases in the incarceration of PMI (Lamb & Grant, 1982; Stelovich,
1979; Swank & Winer, 1976; Whitmer, 1980), as these individuals were no longer in hospitals, but out in the
communityandatriskofarrest(Whitmer,1980).Today,PMIarethreetimesmorelikelytobeinjailorprison
thaninahospitalreceivingappropriatetreatment(Taheri,2016).Thisislargelybecausethecriminaljustice
system is the only social institution that cannot turn away these cases. Private centers can refuse to treat patients
theydeemtoberiskyordisruptive;communitymentalhealthproviderscanrejectthosewhohaveacriminal
history; and hospitals can turn away those who appear threatening or intoxicated.
Criminal justice systems across the country have responded by developing programs aimed at reducing
incarceratedPMIbydivertingthemawayfromthecriminaljusticesystemandintocommunity-basedtreatments
andservices.Servicesprovidedbymanyoftheseprogramsoccur“post-booking”(e.g.,mentalhealthcourts)
and can only be accessed once an individual has been arrested or charged with a crime. Many studies suggest,
however,thatthemosteffectivewayofdivertingPMIfromthecriminaljusticesystemisbyintervening“pre-
booking”aspoliceofcersrespondto911emergencycalls(Muntez&Grifn,2006).
Approximately 10% of law enforcement encounters involve PMI, about three quarters of whom have co-
occurringsubstanceusedisorders(Steadman,2005;Skubbyetal.,2013).Often,policeofcersdon’thave
the resources or training to handle mental health crises effectively, or the people who experience them. During
these encounters, PMI in crisis can exhibit strange or hostile behavior, creating a situational ambiguity that can
compromisethesafetyofofcers(Taheri,2016).Oneofthemostpopularresponsestothisissuehasbeenthe
implementationofCrisisInterventionTraining(CIT),wherepoliceofcersaretrainedaboutmentalillnessand
how to respectfully and safely interact with PMI (Dupont, Cochran, & Pillsbury, 2007; Compton, Bahora, Watson,
&Oliva,2008).Additionally,CITcurriculumalsoprovidestrainingforofcersonco-occurringmentalhealthand
substance use disorders that as many as three quarters of PMI experience (Steadman, 2005; Dupont, Cochran,
&Pillsbury,2007).EmpiricalevidenceonCIThasbeenencouragingandsuggeststhatCIT-trainedofcershave
more positive attitudes, beliefs, and knowledge about mental illness, and agencies with CIT programs have lower
arrest rates than other types of diversion programs (Compton, et al., 2008).
Even with the emergence of CIT programs, police agencies struggle to engage with PMI safely in the communities
they serve. To this end, several police departments have partnered with community healthcare providers to
create co-responding police-mental health teams, known alternatively as mobile crisis intervention teams, crisis
outreach and support teams, and ambulance and clinical early response teams (Shapiro et al., 2014). The
generalco-responseteammodelinvolvespartneringaswornpoliceofcerwithamentalhealthprofessional,
although many agencies create three-person teams by adding a medical professional (such as a nurse or
paramedic) or a peer specialist (such as an individual in recovery from mental illness or substance use disorder)
(Hay, 2015). Dozens of such teams currently operate in North America from Los Angeles, California to Halifax,
NovaScotia,andhaveseveralcommongoals,includingdivertingPMIawayfromthecriminaljusticesystemand
increasing consumer access to mental health and substance abuse treatment (Steadman et al., 2001; Shapiro
et al., 2014). However, one important distinction among these co-responding units is the timing of the response:
LITERATURE REVIEW