Original Article

Costs and Savings Associated with Implementation of a Police Crisis Intervention Team

Authors: Peggy L. El-Mallakh, PhD, Kranti Kiran, MD, Rif S. El-Mallakh, MD

Abstract

Objectives: Police crisis intervention teams (CIT) have demonstrated their effectiveness in reducing injury to law enforcement personnel and citizens and the criminalization of mental illness; however, their financial effect has not been fully investigated. The objective of the study was to determine the total costs or total savings associated with implementing a CIT program in a medium-size city.

Methods: The costs and savings associated with the implementation of a CIT program were analyzed in a medium-size city, Louisville, Kentucky, 9 years after the program’s initiation. Costs associated with officer training, increased emergency psychiatry visits, and hospital admissions resulting from CIT activity were compared with the savings associated with diverted hospitalizations and reduced legal bookings.

Results: Based on an average of 2400 CIT calls annually, the overall costs associated with CIT per year were $2,430,128 ($146,079 for officer training, $1,768,536 for hospitalizations of patients brought in by CIT officers, $508,690 for emergency psychiatry evaluations, and $6823 for arrests). The annual savings of the CIT were $3,455,025 ($1,148,400 in deferred hospitalizations, $2,296,800 in reduced inpatient referrals from jail, and $9825 in avoided bookings and jail time). The balance is $1,024,897 in annual cost savings.

Conclusions: The net financial effect of a CIT program is of modest benefit; however, much of this analysis was based on estimates and average length of stay. Furthermore, the costs and savings associated with officer or citizen injuries were not included because there was inadequate information about their prevalence and costs. Finally, this analysis does not take into account the nonmonetary gains of a CIT program.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Perez A, Leifman S, Estrada A. Reversing the criminalization of mental illness. Crime Delinq 2003;49:62-78.
 
2. McGuire AB, Bond GR. Critical elements of the crisis intervention team model of jail diversion: an expert survey. Behav Sci Law 2011;29:81-94.
 
3. Borum, R, Swanson J, Swartz M, et al. Substance abuse, violent behavior and police encounters among people with severe mental disorders. J Contemp Crim Justice 1998;12:236-250.
 
4. Compton MT, Esterberg ML, McGee R, et al. Brief reports: crisis intervention team training: changes in knowledge, attitudes, and stigma related to schizophrenia. Psychiatr Serv 2006;57:1199-1202.
 
5. Vermette HS, Pinals DA, Appelbaum PS. Mental health training for law enforcement professionals. J Am Acad Psychiatry Law 2005;33:42-46.
 
6. DuPont R, Cochren S. Police response to mental health emergencies--barriers to change. J Am Acad Psychiatry Law 2000;28:338-344.
 
7. Borum R, Deane MW, Steadman HJ, et al. Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness. Behav Sci Law 1998;16:393-405.
 
8. Sirotich F. The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. J Am Acad Psychiatry Law 2009;37:461-472.
 
9. Steadman HJ, Deane MW, Borum R, et al. Comparing outcomes of major models of police responses to mental health emergencies. Psychiatr Serv 2000;51:645-649.
 
10. El-Mallakh RS, Spratt D, Butler C, et al. Evaluation of consequences of implementation of police crisis intervention team in Louisville. J KY Med Assoc 2008;106:435-437.
 
11. Teller JL, Munetz MR, Gil KM, et al. Crisis intervention team training for police officers responding to mental disturbance calls. Psychiatr Serv 2006;57:232-237.
 
12. Deane MW, Steadman HJ, Borum R, et al. Emerging partnerships between mental health and law enforcement. Psychiatr Serv 1999;50:99-101.
 
13. Compton MT, Bahora M, Watson AC, et al. A comprehensive review of extant research on Crisis Intervention Team (CIT) programs. J Am Acad Psychiatry Law 2008;36:47-55.
 
14. Cowell AJ, Broner N, Dupont R. The cost-effectiveness of criminal justice diversion programs for people with serious mental illness co-occurring with substance abuse: four case studies. J Contemp Crim Just 2004;20:292-325.
 
15. Watson AC, Morabito MS, Draine J, et al. Improving police response to persons with mental illness: a multi-level conceptualization of CIT. Int J Law Psychiatry 2008;31:359-368.
 
16. El-Mallakh RS, Wulfman G, Smock W, et al. Implementation of a crisis intervention program for police response to mental health emergencies in Louisville. J KY Med Assoc 2003;101:241-243.
 
17. Steadman HJ, Stainbrook KA, Griffin P, et al. A specialized crisis response site as a core element of police-based diversion programs. Psychiatr Serv 2001;52:219-222.
 
18. Strauss G, Glenn M, Reddi P, et al. Psychiatric disposition of patients brought in by crisis intervention team police officers. Community Ment Health J 2005;41:223-228.
 
19. Weber NS, Cowan DN, Millikan AM, et al. Psychiatric and general medical conditions comorbid with schizophrenia in the National Hospital Discharge Survey. Psychiatr Serv 2009;60:1059-1067.
 
20. MEDPAC. Psychiatric hospital services payment system. http://medpac.gov/documents/MedPAC_Payment_Basics_07_psych.pdf. Published October 2007. Accessed April 21, 2014.
 
21. Cheung AH, Dewa CS, Wasylenki D. Economic grand rounds: impact on cost estimates of differences in reports of service use among clients, caseworkers, and hospital records. Psychiatric Serv 2003;54:1328-1330.
 
22. US Census Bureau. State and county QuickFacts: Jefferson County, Kentucky. http://quickfacts.census.gov/qfd/states/21/21111.html. Accessed April 21, 2014.