Police Officers’ Attitudes Toward Mental Health and Crisis Intervention: Understanding Preparedness to Respond to Community Members in Crisis

Abstract

The lack of robust mental health programs throughout the USA has resulted in police frequently being responsible for responding to calls about people with mental illness who are in crisis. Working with people with mental illness as offenders or as individuals needing emergency assistance is a regular part of the job for many in law enforcement, yet specialized training is not a regular part of most academy or in-service training curricula. Crisis Intervention Team (CIT) programs consist of a 40-h training for police and mental health personnel. The programs teach officers about mental illness, its causes and symptoms, and focuses on de-escalation tactics and use of available community resources as alternatives to criminal justice outcomes for calls. The current study explores officers’ feelings of preparedness to work with community members with mental illness and their levels of endorsement of mental health stigma. Researchers surveyed police from nine different local departments in southern New Jersey. Half of the surveyed officers completed CIT training, allowing for comparisons between officers who were trained and those who were not. Results indicate that the CIT-trained officers were more likely to endorse different types of mental health stigma than non-trained officers, but those who were CIT-trained reported feeling better prepared for calls involving people with mental illness.

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Vol.:(0123456789)
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Journal of Police and Criminal Psychology
https://doi.org/10.1007/s11896-021-09459-6
Police Officers’ Attitudes Toward Mental Health andCrisis Intervention:
Understanding Preparedness toRespond toCommunity Members
inCrisis
ChristineTartaro1 · JessBonnan‑White1· M.AlysiaMastrangelo1· RichardMulvihill1
Accepted: 25 May 2021
© Society for Police and Criminal Psychology 2021
Abstract
The lack of robust mental health programs throughout the USA has resulted in police frequently being responsible for
responding to calls about people with mental illness who are in crisis. Working with people with mental illness as offend-
ers or as individuals needing emergency assistance is a regular part of the job for many in law enforcement, yet specialized
training is not a regular part of most academy or in-service training curricula. Crisis Intervention Team (CIT) programs
consist of a 40-h training for police and mental health personnel. The programs teach officers about mental illness, its causes
and symptoms, and focuses on de-escalation tactics and use of available community resources as alternatives to criminal
justice outcomes for calls. The current study explores officers’ feelings of preparedness to work with community members
with mental illness and their levels of endorsement of mental health stigma. Researchers surveyed police from nine different
local departments in southern New Jersey. Half of the surveyed officers completed CIT training, allowing for comparisons
between officers who were trained and those who were not. Results indicate that the CIT-trained officers were more likely to
endorse different types of mental health stigma than non-trained officers, but those who were CIT-trained reported feeling
better prepared for calls involving people with mental illness.
Keywords Police· Mental illness· Crisis intervention training· Stigma
Introduction
With renewed calls for improved police training in the
wake of controversial encounters between police and dif-
ferent community constituencies, continued examination of
police training is crucial. Changes to the practice of rely-
ing on inpatient psychiatric treatment in the 1960s resulted
in the elimination of psychiatric beds in the USA, with a
decrease from 559,000 beds in 1955 to just 35,000 in 2012
(Torrey 2016). Government funds for the community-based
out-patient clinics also quickly disappeared, leaving too
few psychiatric beds and little resources to care for peo-
ple with mental illness (PwMI) in American communities
(Frank and Giled 2006; Talbott2004; Torrey etal. 2010).
The inadequacy of the mental health system left few options
or resources for PwMI facing a mental health crisis, and cur-
rently, the police are often the last resort (or, as it happens,
first contact) for these individuals, with arrest and incarcera-
tion among the few avenues for accessing treatment (Lurigio
etal. 2008). Markowitz (2006) studied arrest rates in 81
cities in the USA with populations of at least 50,000 and
found an inverse relationship between psychiatric hospital
bed capacity and arrests, even after controlling for cities’
homelessness rates and other structural variables.
Interaction between police and PwMI is defined by two
different types of involvement categories (Teplin and Pruett
1992). One category represents a law enforcement func-
tion, where police take action through application of crimi-
nal statutes to protect the public. People with mental ill-
ness commit crimes, just as those without mental illness do.
During encounters where enforcement activities are taking
place, police officers may be required to “talk down” or sub-
due suspects who are mentally ill or are in crisis during the
arrest process. The second category of police involvement is
non-criminal statute enforcement to protect physically and/
or mentally disabled citizens. These actions are permitted
* Christine Tartaro
Christine.tartaro@Stockton.edu
1 Stockton University, 101 Vera King Farris Drive, Galloway,
NJ08205, USA

Journal of Police and Criminal Psychology
1 3
under the parents patriae doctrine, allowing the government
to take steps to assist residents unable to care for themselves.
It is this latter function, combined with the lack of mental
health resources in the community, that inspired Teplin and
Pruett (1992, p. 339) to refer to police as “street corner psy-
chiatrists.” For many police officers, however, this is not nec-
essarily seen as the primary role of policing (Bittner 1967;
Lane 2019). Most officers lack even rudimentary training on
mental illness and how to respond to calls involving people
in the midst of a psychiatric crisis. A national survey of
law enforcement training academies and police departments
revealed that the median time spent on mental health top-
ics in academies is 20h out of an average of 18.5weeks of
training, while the departments offer a median of 4h mental
health in-service training (Fiske etal. 2020).
One intervention developed to address socio-political
conditions contextualizing mental health treatment in the
USA, and the lack of officer training has been the introduc-
tion of Crisis Intervention Team (CIT) response. CIT is cur-
rently one of the most popular types of police-mental health
collaboration options, with over 2700 programs across the
USA as of 2019 (Rogers etal. 2019). If the Biden administra-
tion works to act on the Obama administration’s President’s
Task Force on 21st Century Policing recommendations, CIT
will be incorporated into police policy and practice even
more frequently in the coming years. CIT training aims to
educate police about mental illness, substance abuse, and
de-escalation while introducing officers to the mental health,
substance abuse, and social service options available in the
communities they serve. CIT training aims to improve offic-
ers’ knowledge and attitudes about mental illness and pro-
duce better outcomes in the field, such as reduced arrests,
less use of force, and more service linkages.
Literature Review
Stigma andMental Illness
In the early days of the USA, PwMI were thought to be pos-
sessed by demons or witches and were subjected to inhumane
treatments or otherwise shunned by society (Brattina2017).
Even today, an unfortunate consequence of mental illness is
that people living with it must also deal with stigma. Public
stigma includes three components. First, there are stereotypes
or negative beliefs about a group. A few negative stereotypes
commonly held by the public about PwMI are that they are
too unstable to be able to develop meaningful relationships,
are violent, and lack proper hygiene habits. Second is preju-
dice or an agreement with negative beliefs and/or an emo-
tional reaction to those beliefs. Third, there is discrimination,
meaning a behavioral response to the prejudice (Corrigan and
Watson 2002). There has been little improvement in battling
stigma of PwMI over the years. Phelan etal. (2000) com-
pared survey data from 1950 to survey results from 1996.
During both time periods, respondents were asked to define
mental illness and provide descriptions of PwMI and their
behavior. The odds of respondents in 1996 describing PwMI
as violent were nearly twice that found in the survey from
1950.
Criminal justice personnel are not immune from being
influenced by public stigma against mental illness. Watson
etal. (2004) asked police in Chicago to complete some
vignettes, all of which included stories of a minor criminal
event or disturbance. The scenarios differed in that some
included the word “schizophrenia” to describe one of the
actors, while the other vignettes had no mention of a psy-
chiatric diagnosis. All scenarios lacked specific information
about the suspect’s behavior or demeanor, as the goal was
to examine how the presence of one word—schizophrenia—
would impact results among officers. Officers rated the sus-
pect with schizophrenia to be more dangerous and perceived
witnesses diagnosed with schizophrenia to be less credible.
There may be potential for adverse outcomes after initial
police contact with PwMI if an individual officer holds
stigma toward their own mental health and negative associa-
tions in regard to mental illness, criminality, victimization,
and credibility (Bullock and Garland 2018).
Interaction Between Police andPwMI
Since officers occupy a dual role of protecting the public and
assisting those in need, interaction with PwMI is a regular
part of police work in departments of all sizes (Clayfield
etal.2011; Engel and Silver 2001; Ruiz and Miller 2004;
Wells and Schafer 2006). Most police-citizen interactions
end without an arrest or use of force, but a person’s mental
illness has the potential to make the encounter more chal-
lenging for both the police and civilians. The presence of a
mental illness may inhibit effective communication between
citizens and police, with some PwMI having difficulty obey-
ing officer commands (Kerr etal. 2010). Ruiz and Miller
(2004) identified fears PwMI may have that may cause them
to act in ways police could misinterpret, prompting the use
of force. For example, PwMI may fear being detained and
taken away by strangers. They may fear people who are yell-
ing and issuing stern commands, as officers are frequently
trained to do to gain control at a scene. Finally, individuals
in crisis may have a general fear of police and government
authorities in general.
In addition to community members’ responses to police
contact, police officers may themselves fear PwMI due to
perceptions of dangerousness and misinterpretation. For
example, a PwMI’s failure to comply with commands may
be interpreted as aggressive behavior and prompt officer use
of force (Kerr etal. 2010). Additionally, officers’ lack of

Journal of Police and Criminal Psychology
1 3
understanding of mental illness and its symptoms may lead
to an absence of empathy. In a study of Pennsylvania police
officers’ perceptions of PwMI, nearly half of the officers
surveyed reported feeling uneasy or threatened when having
to respond for calls for service involving PwMI (Ruiz and
Miler 2004). Sixty percent of surveyed officers in Indiana
identified repeat calls for service involving PwMi as either
a moderate or significant problem (Wells and Shafer2006),
while approximately half of the sampled officers in Birming-
ham Alabama, Memphis Tennessee, and Knoxville, Tennes-
see considered mental health calls to be a moderate or big
problem (Borum etal. 1998). In an analysis of de-escalation
training, participating officers identified mental illness (and
the combination of mental illness with drug and alcohol use)
as a barrier to employing effective de-escalation techniques
(Todak and White 2019). As communities rely more heavily
on police resources to address issues of mental illness, atten-
tion should be paid to attitudes police officers hold about
mental illness and the impact of relevant training on these
attitudes. As with other areas of training, such as procedural
justice (Dai etal. 2020), de-escalation (Todak and White
2019), social identity awareness (Israel etal. 2017; Miles-
Johnson2016), physical ability and neurodiversity sensitiv-
ity (Viljoen etal. 2017), and sexual assault assistance and
trauma-informed practice (Franklin etal. 2020; Parratt and
Pina 2017; Sleath and Bull 2012), indirect, attitudinal meas-
ures comparing trained and non-trained officers, as well as
retention of training effects on attitudinal changes provide
scholars and practitioners with insight on the professional
impact of training. The value of this insight lies not only
in evaluation of specific training interventions, but also
in addressing expectations community members hold that
training transforms police attitudes, behavior, and policy.
Similar to other training foci (Viljoen etal. 2017), indirect
assessments of CIT training’s impact on officers’ attitudes
continue to compliment analysis of direct training outcomes
(changes to observed behaviors, increased use of community
partner resources, etc.). The current paper seeks to explore
attitudes held by officers and whether previous with Crisis
Intervention Team training is associated with a particular
set of beliefs.
Preparing Officers forPolice‑Citizen Interactions
Involving PwMI—Crisis Intervention Training
While the majority of police-citizen interactions with PwMI
generally involve low-level criminal behavior and do end
peacefully (Brekke etal. 2001; Kaminski etal. 2004; Wells
and Schafer 2006), there have been well-publicized incidents
of PwMI being injured or killed by police. Several of the
most controversial police encounters in recent years have
included PwMI or individuals in the midst of an emotional
crisis. In an examination of 462 police shootings in the first
6months of 2015, the Washington Post reported that a quar-
ter of those shot by police were either diagnosed as mentally
ill or in emotional distress at the time of the incident. Over
half the law enforcement agencies involved in these inci-
dents had provided little training to equip their staff with
the ability to recognize the signs of a mental health crisis
or understand the importance of de-escalation techniques
(Lowery etal. 2015). This lack of knowledge and training
among police has the potential to lead to harmful outcomes
when officers respond to incidents involving people whose
behavior is being impacted by mental illness.
CIT training was developed in response to a controver-
sial police shooting in Memphis, Tennessee, in 1987. After
being called to a scene where a citizen was injuring them-
selves with a knife and expressing suicidal thoughts, multi-
ple police officers arrived at the scene and shot the suicidal
man several times, killing him. Following the public outcry,
faculty from the University of Tennessee, officers from the
Memphis Police Department, and staff from the National
Alliance on Mental Illness (NAMI) developed a curriculum
for a 1-week intensive, 40-h training program. Unlike typi-
cal trainings, CIT aims to be a joint venture between police,
mental health professionals, and community service provid-
ers. Officers learn about the symptoms of mental illness,
practice de-escalation skills, get to know the mental health
professionals in their communities, and gain an understand-
ing of the non-criminal justice resources available in their
jurisdiction. CIT programs aim to produce police officers
who can serve as specialized first responders equipped with
the skills and knowledge to reduce negative police-citizen
interactions and utilize appropriate services to assist peo-
ple with mental illness (Compton etal. 2008; Lurigio etal.
2008). After acknowledging the history of problematic
police-community relations throughout the USA, President
Obama’s Task Force on 21st Century Policing called for
more CIT training as one of several steps needed to help
police fulfill the role of “guardians” of their communities
(The President’s Task Force on 21st Century Policing2015).
CIT training has the potential to change officers’ attitudes
toward PwMI and give them the knowledge and skills to
handle calls non-violently and link people with appropri-
ate services (Lurigio etal. 2008). Research findings, how-
ever, have been mixed. Wells and Schafer (2006) surveyed
police in Indiana before and after completing CIT training.
Officers reported significant improvements in their levels
of comfort in interacting and communicating with PwMI
and their understanding of the work necessary to arrange
for inpatient psychiatric hospital treatment. Ritter etal.
(2010) tracked officers in a Midwestern city as they com-
pleted CIT training and found improvements in feelings of
preparedness to handle calls involving PwMI. The officers’
perceptions of the helpfulness of the mental health system
also improved as they learned how to access community

Journal of Police and Criminal Psychology
1 3
services that could serve as alternatives to incarceration.
Compton etal. (2011) compared CIT-trained officers to
those who had not taken CIT training and found that the
former were more likely to respond to vignettes about calls
concerning PwMI by favoring options other than use of
force. Compton etal. (2011a, b) compared police officers
on their feelings of empathy before and after CIT training.
Results were mixed, with officers experiencing changes on
some, but not all, measures of empathy after CIT training.
Compton etal. (2014) studied 251 CIT-trained officers and
335 officers without the training to compare the two groups
on stigma levels, self-efficacy, de-escalation skills, referral
decisions, and attitudes toward people with serious mental
illness and their treatments. After controlling for officer age,
gender, years of service, education, on-the-job experience,
empathy scores, and personal and family experience with
PwMI, CIT-trained officers received higher scores on their
knowledge of mental-illness de-escalation skills, held more
positive attitudes about treatment, and reported lower scores
on fear and negative attitudes toward PwMI. Finally, Haigh
etal. (2018) administered Day’s Mental Illness Stigma Scale
(Day etal. 2007) to officers and compared those who had
CIT training to those who did not. The researchers found no
significant differences in levels of stigma toward mentally ill
individuals. This was an unexpected finding, and there are
multiple possible explanations. One, of course, is that CIT
does not impact individuals’ beliefs in negative stereotypes
among PwMI. Another possibility that the authors noted was
that departments struggling with PwMI calls might be send-
ing their staff members who are having the most problems
with community interactions to training. In that case, the
training might have impacted their stigma ratings but only
brought them down to the same level of other officers who
were deemed to not need CIT.
Previous research suggests personal and professional
experiences could impact officers’ thoughts about CIT
training, PwMI, and feelings of preparedness for han-
dling mental health calls. Several studies have explored
the relationship between individuals’ personal experi-
ence with psychological challenges and attitudes toward
PwMI. In a large sample (n = 5200) of adults in the USA,
respondents who knew someone with mental illness had
more favorable attitudes toward PwMI (Kobau etal. 2010).
Clayfield etal. (2011) reported that police reporting his-
tory of personal involvement with PwMI outside of work
felt better prepared to interact with PwMI while on duty.
Karaffa and Koch (2016) surveyed police officers in Texas
and Oklahoma about their personal experience with men-
tal health treatment. Nearly 60% of participants reported
voluntarily participating in mental health treatment, and
these individuals had better attitudes about seeking pro-
fessional assistance and lower self-stigma scores. There
was no difference in perceptions of public stigma. The
authors did note that the prevalence of officer involvement
in mental health treatment was high for this sample, and
they attributed that to the voluntary nature of the survey.
It is possible that some of these results are a product of
sample bias, with individuals having more experience with
and positive attitudes toward mental health intervention
agreeing to complete the survey. Soomro and Yanos (2019)
surveyed police officers and asked them about their current
mental health symptoms and their opinions of PwMI. The
officers who described symptoms matching characteristics
of PTSD tended to endorse stigma at higher levels than
other officers. The researchers speculated that it is possible
the responding officers were unaware that they had PTSD,
and the possible lack of awareness of their own mental
health problems prevented them from feeling empathy
toward people identified as mentally ill.
Compton and colleagues (2015) observed that, in their
sample of Georgia police officers, CIT-trained police were
more likely to have both family and friends with histo-
ries of mental health treatment than officers who had not
been CIT trained. Using what appears to be the same set of
data from Georgia, Compton etal. (2014) reported offic-
ers’ own history with the mental health system and that
of their family and friends was not associated with how
officers completed vignettes involving PwMI once CIT
training was considered in the models. In another exam-
ple, Compton etal. (2011a, b) found that volunteering for
CIT training was associated with having family and friends
with histories of mental health system involvement. How-
ever, neither the association with these family or friends
nor volunteering for CIT training were significant factors
when measuring changes in empathy of officers before ver-
sus after CIT training. Cuddeback (2016) also considered
the mental health of family and friends when studying the
impact of CIT training on officers’ opinions about mental
illness. They also found that family and friends’ mental
illness did not impact officer opinions regarding PwMI.
Therefore, although it might be tempting to assume expo-
sure to mental illness and treatment within close social
or family circles or willingness to engage in CIT training
would impact an officer’s sense of stigma regarding PwMI
or attitudes toward mental illness, data presented in the
scholarly literature are equivocal.
The purpose of the current study is to examine two groups
of police officers, those with previous CIT training and those
without, on stigma toward PwMI and personal preparedness
to handle mental health service calls. According to Tully
and Smith (2015), police perception of mental illness is
one of five categories of analysis relevant to the assessment
of CIT interventions and effectiveness. Given the content
of CIT training, we expect that CIT-trained officers would
report feeling more confident about handling calls involv-
ing PwMI and would be less likely to hold negative beliefs

Journal of Police and Criminal Psychology
1 3
about mental illness. Specifically, we tested the following
hypotheses:
1.CIT-trained officers will report lower levels of stigma
against individuals with mental illness.
2.CIT-trained officers will feel more prepared to handle
mental health calls and incidents involving PwMI in cri-
sis.
Methodology
Between September 2019 and March 2020, the researchers
recruited nine police departments across five southern New
Jersey counties. Data were collected as part of a larger study
of officer experiences and attitudes regarding work and rela-
tionships with their service communities. The researchers
approached the chiefs of the departments to explain the goals
of the research, provide reassurances of anonymity, and dis-
cuss preferences for survey administration. Chiefs willing to
distribute print versions of the survey were given the appro-
priate number of copies along with envelopes. The chiefs
gave the officers the surveys, along with an IRB-approved
cover letter from the research team explaining the study’s
purpose, the voluntary nature of the survey, and promises
of anonymity. The cover letter asked officers who consented
to participate to begin filling out the survey. If they did not
consent, they were instructed to discard it. Participants
placed the completed print surveys in sealed, unmarked
envelopes and then dropped them in a collection box in the
station. The research team then picked up the surveys after
a few weeks. If the chiefs preferred email distribution, the
research team emailed the chiefs a link to the consent form
and survey, and the chiefs then forwarded it to the officers.
The email link took participants to a Qualtrics-based survey.
Between the print and electronic versions, surveys were dis-
tributed to a total of 590 officers, with 168 returned surveys
complete enough to be included in the final dataset (28.6%
response rate). One participant responded “I don’t know”
when asked whether they completed CIT training, so that
case was removed, leaving 167 for analysis.
For this paper, the focus is officers’ endorsement of men-
tal illness stigma and perceptions of preparedness to handle
calls involving PwMI. These are potentially sensitive ques-
tions that might prompt people to provide socially desirable
answers. Officers might be hesitant to disclose their personal
mental health treatment experience, and they also might be
reluctant to admit to harboring negative thoughts about
PwMI. To address potential concerns regarding participa-
tion, the research team took steps to protect the identity of
both participating departments and individual respondents.
First, we agreed to never identify the participating depart-
ments and to only discuss the results in aggregate. Second, to
protect individual participants, we limited data collection to
avoid compromising anonymity, so the surveys did not con-
tain questions about participants’ gender or race/ethnicity.
The 2016 Uniform Crime Report data indicated departments
in the sampled counties had only 4 to 9% of female officers
(State of New Jersey2017), so female officers would have
likely jeopardized their anonymity by responding to such a
demographic question. In taking these steps, the research
team hoped to create a sense of anonymity among partici-
pants. While it is always possible that social desirability still
impacted respondents’ answers, these steps were taken to
limit, to the extent we could, this possibility.
Results
Univariate Analysis
In the survey, respondents were asked whether they ever
completed the 40-h CIT training. Responses were evenly
distributed across the sample, with 83 individuals (49.4%)
having completed CIT training while 85 (50.6%) had not
(Table1). We also asked about their years of law enforce-
ment experience, with this agency or others, and the number
of times they encountered a PwMI who was in crisis while
on duty in an average month over the past year. Respond-
ents had a wide variety of law enforcement experience, with
10% (n = 17) being on the job for less than 5years, 20%
(n = 33) working for 5 to 10years, 39% (n = 66) for 11 to
20, 27% (n = 46) for 21 to 25years, and 4% (n = 6) for over
25years. Due to the low frequencies for newer and very
experienced officers, the five categories were condensed to
3 up to 10years, 11 to 20years, and 21 + years, for analy-
sis. Similar to results of previous research, the officers in
our sample varied a great deal in the extent to which they
interacted with PwMI in crisis while on duty in an aver-
age month. No one in the sample reported having zero such
interactions in a typical month. A quarter (n = 43) of officers
estimated that they had one to two encounters with PwMI in
crisis, on average, each month, and a 21% (n = 35) reported 3
or 4 such encounters. Slightly over half (52%, n = 88) of the
survey respondents recalled having at least five interactions
with PwMI in crisis per month in the past year.
The survey included multiple questions to measure the
mental health history of the officers as well as their friends
and family (Table1). First, officers were asked if they were
currently or had ever received mental health treatment, such
as therapy, counseling, or medicine for emotional problems.
Next, they were asked the same question regarding family
and friends. Officers were then asked if they had experi-
ence working or volunteering in the mental health field, such
as therapy, counseling, psychiatry, or psychology. Finally,
they were asked the same about their family and friends. For

Journal of Police and Criminal Psychology
1 3
this analysis, we created the same experience index used by
Compton etal. (2014) in their study of officers participat-
ing in CIT training. The index was scored on a scale of 0
to 5. Respondents received a 0 if they indicated that they,
their friends, and their family had no experience with the
mental health system via receiving treatment, volunteer-
ing, or working in the system. Respondents scored a 1 if
they, their family, or friends at some point held a volun-
teer position or worked in the mental health system. Scores
of 2 were for respondents who had a friend who received
mental health treatment, and 3 was for people who had a
family member who experienced mental health treatment. If
individuals replied that they had both a family member and
a friend who received mental health treatment, they were
coded as a 4. If the respondents themselves indicated that
they received mental health treatment, it was coded as a 5.
The mean level of exposure for the responding police was
1.82 (Mdn = 2.0; SD = 1.68). To measure officers’ opinions
about mental illness stigma, respondents completed Day’s
Mental Illness Stigma Scale (Day etal.2007). The scale
consists of 28 statements measured on a seven-point Likert-
type scale (completely disagree = 1; completely agree = 7)
and includes seven domains: treatability, relationship disrup-
tion, hygiene, anxiety, visibility, recovery, and professional
efficacy. The Anxiety factor (7 items) reflects the extent to
which respondents feel uneasy, nervous, or fearful for their
safety when in the presence of someone with mental illness.
Visibility (4 items) measures individuals’ perceptions about
their ability to recognize symptoms of mental illness. Rela-
tionship Disruption (6 items) assesses concerns about the
impact of mental illness on quality of interpersonal relation-
ships. Hygiene (4 items) measures opinions about the self-
care and cleanliness of PwMI. Finally, Treatability (3 items),
Professional Efficacy (2 items), and Recovery (2) reflect the
respondents’ beliefs about the prospects of recovery and the
extent to which mental health professionals are able to con-
tribute to effective treatment practices.
Mean responses to the Mental Illness Stigma Scale are
displayed in Table2. To test for reliability of the seven
domains included in the scale as well as the total score, we
calculated Chronbach’s alpha, utilizing a value of 0.70 for
Table 1 Law enforcement
experience fPercent
CIT trained
Yes 83 49.4
No 85 50.6
Years of experience in law enforcement
Less than 5 17 10.1
5–10 33 19.6
11–20 66 39.3
21–25 46 27.4
Over 25 6 3.6
In an average month over the past year, how many encounters have you had
with people with mental illness in crisis while on duty?
0 0 0.0
1 24 14.3
2 19 11.3
3 18 10.7
4 17 10.1
5 19 11.3
6 to 10 34 20.2
More than 10 35 20.8
No answer 2 1.2
Mean SD
Exposure to the mental health system scale 1.82 1.68
Table 2 Mental illness stigma
α M Mdn SD
Relationship disruption .916 4.53 4.5 1.43
Hygiene .934 4.89 5.0 1.38
Anxiety .954 4.85 5.3 1.59
Visibility .794 3.86 4.0 1.14
Treatability .751 4.86 5.0 1.45
Recovery .868 4.74 5.0 1.72
Professional efficacy .801 4.66 5.0 1.38
Total mental illness scale score .955 130.62 136.0 31.48

Journal of Police and Criminal Psychology
1 3
acceptable inter-correlation. Six of the seven factors and the
scale’s total produced acceptable alpha scores. The reliabil-
ity coefficient for Visibility was α = 0.664 but rose to 0.794
upon the removal of one of the four variables included in
the factor. Following reliability analysis, means for each
factor subscale were calculated. After reverse-coding some
items, higher scores for each factor represent higher levels
of endorsement of stigma. Respondents were given a 7-point
scale to score each item, with 1 representing “completely
disagree” and seven “completely agree.” Most of the mean
responses were in the 4.5 to 4.89 range, indicating slight
agreement with stereotypes concerning the role of mental
illness in Relationship Disruption (M = 4.53) and nega-
tive attitudes toward Hygiene (M = 4.89) stereotypes about
PwMI. Respondents somewhat agreed with statements
regarding them being anxious around people with mental
illness (Anxiety mean = 4.85) and statements expressing
skepticism about the Treatability (M = 4.86), prospects of
Recovery (M = 4.74), and mental health professionals’ ability
to treat mental illness (Professional Efficacy mean = 4.66).
Respondents had the lowest mean scores for the Visibility
domain, with a mean of 3.86 and a median of 4.0, suggest-
ing that officers lacked confidence in their ability to look
at someone and determine that they have a mental illness.
Possible total scores on the entire scale could have ranged
from 28 to 196. Respondents’ scores ranged from a low of
44 to a high of 191. The total mean was 130.62 (SD = 31.48).
Reliability for the entire scale was high, with α = 0.955.
Table3 includes summary responses to officers’ feel-
ings of preparedness to handle incidents involving PwMI
in crisis. No officers reported feeling “not at all prepared.”
Forty-six percent (n = 78) felt “very prepared,” while 48%
(n = 80) were “moderately prepared.” Only six percent
(n = 10) of respondents reported being “somewhat pre-
pared.” Given the low frequency for “somewhat prepared,”
that category was combined with “moderately prepared,”
creating a dichotomous variable for further analysis.
Bivariate Analysis
The researchers conducted a chi-squared test to measure pos-
sible differences between the CIT-trained and not-trained
groups on their years of law enforcement experience. There
were no statistically significant differences between the
CIT trained and not-trained officers based on their years of
law enforcement experience (Table4). CIT-trained officers
scored a mean of 1.60 (SD = 1.60) on the mental health sys-
tem exposure scale. Non-CIT-trained officers had a slightly
higher score of 2.04 (SD = 1.74), but the results of the inde-
pendent samples t test were not statistically significant.
Finally, we conducted a Mann–Whitney U test to assess for
differences in frequency of PwMI encounters on duty. While
the CIT-trained officers did report more monthly interactions
with PwMI (mean ranks = 88.92 and 78.21 respectively), the
difference was not statistically significant.
Table5 displays independent samples t test and chi-squared
results, with officers’ CIT training as the dichotomous inde-
pendent variable. The Bonferroni correction was used to
account for possible Type I errors. Since there were eight t
tests, we divided the customary alpha of 0.05 by 8, result-
ing in a much more conservative alpha of 0.006. T tests on
the domains of the Mental Illness Stigma Scale did produce
Table 3 Officer feelings of preparedness
Very prepared Moderately prepared Somewhat prepared
Prepared to handle incidents involving PwMI in crisis 78 (46.4%) 80 (47.6%) 10 (6.0%)
Table 4 Bivariate analysis:
CIT training and officer
characteristics
CIT trained (N = 83) Not CIT trained
(N = 84)
f%F%X2
Years of experience in law enforcement
10years or less 23 46.0 27 54.0 4.402
11 to 20years 39 59.1 27 40.9
21 + years 21 40.4 31 59.6
Mean SD Mean SD t
Respondents’ exposure to the
mental health system
1.60 1.60 2.04 1.74 − 1.654
Mean rank Mean rank Mann–Whitney U
Number of encounters with
PwMI in crisis in average month
88.92 78.21 2999.5

Journal of Police and Criminal Psychology
1 3
several statistically significant differences between officers.
Most of the differences, however, were in the opposite direc-
tion as hypothesized. CIT-trained officers had statistically
higher mean responses for Treatability, Relationship Disrup-
tion, Hygiene, and Anxiety, indicating greater stigmatizing
attitudes toward mental illness. Cohen’s d statistics for all
demonstrated a moderate effect size, with statistics for each
ranging from 0.45 to 0.62. The strongest relationships were
found with Treatability (d = 0.62) and Hygiene (d = 0.60).
Mean differences for Recovery were not significant after appli-
cation of the Bonferroni correction. The only domain in which
the CIT-trained officers had somewhat lower scores than the
non-trained officers was for Visibility, but those differences
were not statistically significant. There was no relationship
between officer training and beliefs regarding Professional
Efficacy. There was a significant difference in total scores,
with CIT-trained officers having a mean score of 140.64
(SD = 26.89), while non-trained officers scored an average of
121.10 (SD = 32.71) (t(154) = 4.065, p < 0.06).
To test whether CIT officers felt that they were more pre-
pared to handle incidents involving PwMI who are in cri-
sis, we conducted a chi-squared test (Table5). Fifty-seven
percent (n = 47) of CIT-trained officers felt very prepared to
handle incidents involving PwMI, compared to 37% (n = 31)
of non-trained officers. This difference was statistically sig-
nificant at the p < 0.01 level, but association was rather weak
(Cramer’s V = 0.202).
Additional officer-level factors that might be associated
with preparedness for working with PwMI and levels of
mental illness stigma are years of law enforcement expe-
rience and personal and family/friend experience with the
mental health system. Officer experience was divided into
three categories: 10years or less, 11 to 20years, or 21years
or more, so it was necessary to use one-way ANOVA
(Tables6 and 7). Years of experience was not associated
with officers’ feelings of preparedness when working on
mental health calls with people in crisis, nor was it related to
endorsement of stigma. We asked officers about how many
encounters they had with PwMI in crisis in a typical month
while on the job. Respondents were able to choose any num-
ber from 0 to 5 or from two other categories: “6 to 10” or
“more than 10”. Given the ordinal nature of this variable, we
used Spearman’s Rho to test for correlations between officer
encounters with PwMI and the dependent variables. We did
not find any relationships between officers’ reported experi-
ence with PwMI and endorsement of mental illness stigma
or feelings of preparedness to handle encounters with PwMI
(output available upon request).
For personal or vicarious exposure to the mental health
system, the researchers used Pearson’s r correlation coef-
ficients with Bonferroni’s correction (α = 0.05/8 = 0.006).
Personal, family, and friend involvement with the mental
health system was not associated with any of the individual
domains of the stigma scale, nor was it correlated with the
scale’s total score. Logistic regression analysis was used to
test the relationship between exposure to the mental health
system and officers’ perceptions of preparedness to handle
incidents involving PwMI in crisis (output available upon
request), but the two variables had no association.
Discussion
Officers participating in this study interacted with PwMI
somewhat frequently, with half of the sample responding
to more than one call per week in a typical month. Recent
highly publicized incidents involving officer use-of-force
have been met with calls to provide less funding to law
Table 5 Bivariate analysis: CIT
training and dependent variable
*p < .006;**p < .01
CIT trained Not CIT trained
M SD M SD t d
Treatability 5.33 1.29 4.43 1.45 − 4.210* .62
Relationship disruption 4.91 1.39 4.16 1.39 3.487* .52
Hygiene 5.33 1.20 4.49 1.43 4.064* .60
Anxiety 5.23 1.37 4.51 1.70 2.965* .45
Visibility 3.68 1.18 4.03 1.09 − 2.003 − .31
Recovery 5.13 1.48 4.39 1.85 − 2.860 .43
Professional efficacy 4.78 1.29 4.51 1.46 − 1.274
Total mental illness scale score 140.64 26.89 121.10 32.71 4.065* .65
f%f% X2Cramer’s V
Prepared to handle incidents
involving PwMI in crisis
Very prepared 47 56.6 31 36.5 6.859** .202
Moderately/somewhat prepared 36 43.4 54 63.5

Journal of Police and Criminal Psychology
1 3
enforcement and, instead, give greater funding and respon-
sibility to social service agencies to address calls for PwMI.
While we may have more human service involvement in
cases involving PwMI in the future, it is likely that police
will still be first responders and participate in calls for ser-
vice, especially ones involving reports of criminal behavior.
If CIT programs are to be expanded and relied upon to help
police navigate calls for service with individuals in crisis,
more research is necessary to determine what, if any, impact
this has on officers’ perceptions and behaviors. The current
study focused on the former, as the researchers were unable
to measure officers’ actual use of CIT lessons on duty with
the current dataset. Instead, we focused on officer percep-
tions. Corrigan etal. (2000,2001,2012) researched methods
for combatting stigmatizing attributions about mental ill-
ness and identified education as an effective tool. CIT train-
ing involves educating police about mental illness and its
symptoms while also debunking myths. As it is designed,
CIT training should potentially improve officers’ perceptions
of PwMI, prompt officers to favor nonuse-of-force options
during calls for service, and have them feel more prepared
to handle calls involving PwMI.
We found no support for our first hypothesis. There were
some differences in officer endorsement of stigma against
PwMI but, contrary to our prediction, CIT-trained offic-
ers were more likely to hold more negative opinions about
PwMI than the non CIT-trained officers. We did find sup-
port for Hypothesis 2, in that CIT-trained officers were more
likely to report feeling “very prepared” to handle calls and
incidents involving PwMI in crisis than non-trained officers
who were more likely to indicate they felt “moderately” or
“somewhat” prepared. Possible explanations for these find-
ings are provided below.
In Hypothesis 1, the researchers predicted that CIT-
trained officers would be less supportive of stigmatizing
attitudes toward PwMI than officers who have not yet had
the training. For four of the seven domains of the stigma
scale and the total score, CIT-trained officers had higher
levels of stigma endorsement than the non-trained officers.
Years of law enforcement experience, frequency of contact
Table 6 Bivariate analysis:
officer experience and
dependent variables
10years or less 11 to 20years 21 + years
M SD M SD M SD F
Treatability 4.68 1.54 4.79 1.49 5.12 1.29 .272
Relationship disruption 4.64 1.50 4.56 1.38 4.38 1.44 .655
Hygiene 5.10 1.28 4.73 1.41 4.89 1.45 .358
Anxiety 5.09 1.76 4.69 1.55 4.80 1.48 .412
Visibility 3.80 1.13 3.84 1.11 3.94 1.20 .817
Recovery 4.86 1.91 4.73 1.65 4.67 1.63 .906
Professional efficacy 4.54 1.56 4.71 1.25 4.66 1.37 .794
Total mental illness scale score 132.70 32.29 127.26 31.65 132.13 30.95 .502
f%f%f%X2
Prepared to handle incidents
involving PwMI in crisis
Very prepared 20 49.0 30 45.5 24 46.2 .157
Moderately/somewhat prepared 26 51.0 35 54.5 28 53.8
Table 7 Exposure to the mental health system and mental illness stigma
*p < .006
MH system
exposure
Treatability Relationship
disruption
Hygiene Anxiety Visibility Recovery Profes-
sional
efficacy
Total mental
illness stigma
score
MH system exposure 1.00 − .053 .019 − .069 − .058 .122 − .065 .034 − .040
Treatability 1.00 .659*.606*.757* − .107 .704*.431*.829*
Relationship disruption 1.00 .728*.744*.212*.711*.186 .891*
Hygiene 1.00 .695*.275*.621*.198 .841*
Anxiety 1.00 .021 .800*.213*.920*
Visibility 1.00 .034 − .243*.168
Recovery 1.00 .287*.842*
Professional efficacy 1.00 .341*

Journal of Police and Criminal Psychology
1 3
with PwMI in crisis on calls for service, and the extent of
officers’ personal or vicarious exposure to the mental health
system were not associated with stigma scores. Most previ-
ous research on CIT training found that CIT officers have
better attitudes and opinions about PwMI. One exception
was the Haigh etal. (2018) research, which used the same
mental illness stigma scale as the current study and found
no relationship between training and perceptions of stigma.
Haigh and colleagues provided two potential explanations
for their findings. One was that CIT training does not impact
perceptions of officers after they have been out of CIT train-
ing for some time. Another possibility was that officers who
have been more problematic in their interactions with the
public, particularly PwMI, might find themselves assigned
by their supervisors to CIT training in an effort to improve
their attitudes and behavior. If the latter was the case, Haigh
etal.’s null findings could signify an actual improvement
in the problematic officers’ attitudes to put them more in
line with their colleagues. Both explanations are poten-
tially applicable to the current findings. We did not meas-
ure whether officers volunteered for CIT training or were
ordered to attend. Compton etal. (2014, 2015) collected
data comparing non-trained officers, CIT officers who vol-
unteered, and CIT officers who were assigned to the pro-
gram. Volunteering for CIT, however, was not a significant
predictor of levels of empathy when included in multivari-
ate analysis (Compton etal.2014, 2015). A third possible
explanation is that the two groups of officers are conceptu-
alizing mental illness differently. Mental illness is a broad
term that can refer to a wide array of diagnoses, symptoms,
and behaviors. It could mean moderate depression, severe
schizophrenia, or even drug and alcohol abuse. Research-
ers found that people have different opinions about stigma
depending on the specific type of diagnosis (Day etal.2007;
Mann and Himelein2004: Phelan etal.2000). The survey
used for the current study asked questions about mental ill-
ness in general rather than identifying a particular diagnosis,
such as depression or schizophrenia.
The current analysis did find support for Hypothesis 2.
Our results support previous findings of similar feelings of
confidence and preparedness among CIT-trained officers
(Bonfine etal.2014; Compton etal.2008; Ritter etal.2010;
Taheri2016). A higher frequency of CIT-trained officers
reported feeling “very prepared” to handle calls involving
PwMI in crisis. However, the impact of confidence and pre-
paredness on field practice outcomes remains unclear. Cer-
tainly, recognition of bias and stereotypes regarding mental
illness is an important factor in creating organizational-level
priorities for professional development and creating informed
department policies. However, beyond policy development
and organizational recognition, future research must incorpo-
rate assessment of specific community experience or policing
practice outcomes beyond officer perceptions.
The current research consisted of a survey of police
employed at several different departments, half of whom
previously attended CIT training. Learning whether offic-
ers have attended the training is only part of the story when
we attempt to understand organizational culture and how
officers might view PwMI and their responsibility for their
health and safety. Cotton and Coleman (2017) identified
three generations in the evolution of police policies for inter-
acting with PwMI. The first generation focused on offering
or mandating education and awareness programs, includ-
ing CIT. The second generation included creating police-
mental health agency partnerships where mental health
workers assist police in the communities as they respond
to calls. Cotton and Coleman noted that what is rare, yet
necessary, is the third generation of policy wherein each
department identifies and articulates a systematic strategic
approach to address whole problems in their communities.
Cotton and Coleman also argue this broader approach pri-
oritizes changing the entire organizational culture to require
all staff to treat PwMI with respect, adhering to principles of
procedural justice. The concern is that anything short of this
results in mere reaction to symptoms of the problem instead
of a comprehensive, proactive plan for a solution. CIT is
a good start to addressing the challenges of working with
PwMI in our communities, but even supporters of the first
and second generation policies note that training is just one
step that is likely to be ineffective without cultural change
and leadership buy-in (Council of State Governments2019;
Hartford etal.2006). Measuring departmental-level shifts
requires a more nuanced attempt at examining officer atti-
tude—one not possible with the current project’s approach.
Future research, therefore, would benefit from localized
evaluation strategies embedded in objectives determined by
department leadership and their reasons for sending officers
to CIT training.
Limitations
There are a number of limitations associated with this study.
The cross-sectional nature of the data collection prevents an
examination of time-order. It is not possible to ascertain the
CIT-trained officers’ levels of confidence and perceptions
of mental health stigma prior to their training. Given the
findings here of increased levels of agreement with mental
illness stigma among CIT-trained officers, it is important
to have pre-test measures to understand where all partici-
pants were at baseline. Additionally, we are unaware of how
long ago each officer completed CIT training, so we cannot
determine whether our findings are a product of the CIT
training or if the training’s impact has worn off over time.
While previous research did not find the means by which
officers entered CIT training (by volunteering or being

Journal of Police and Criminal Psychology
1 3
assigned by supervisors) to be related to officer knowledge
and empathy levels post-training, future research should
include reason for entering the training as a control vari-
able. In this study, officers were not asked about any other
mental health–related training that they might have received
in addition to or instead of CIT. Participating officers were
from nine different police departments in five different coun-
ties, meaning that respondents attended different CIT pro-
grams. One problem with conducting large-scale CIT studies
is the range in fidelity to the original Memphis model CIT
program (Peterson and Densley2018; Watson etal.2017).
The researchers were unable to identify and study each CIT
program that participants attended.
All of the survey questions regarding mental illness were
very broad, as the term “mental illness” is an umbrella term
for conditions experienced by millions of people, all with
different symptoms and levels of severity. Research reveals
that people have different responses to questions about PwMI
depending on the specific diagnosis or how they operation-
alize mental illness themselves. For example, Phelan etal.
(2000) compared survey responses from Americans in 1950
and 1996 and found that, in both time periods, people who
used the word “psychosis” to describe mental illness were
more likely than others to also use the word “violence.”
Mann and Himelein (2004) found greater levels of stigma
when vignettes described a person as having schizophrenia
compared to when the subject had depression. Given how
new information is being incorporated into the public’s
understanding of different mental illnesses, it might be of
benefit to be more specific in future research on police atti-
tudes toward different mental illness diagnoses. It is likely,
we speculate, that greater specificity on survey questions
might have produced different results. Finally, validity of the
results is limited in that the data reported here represent self-
reports and perceptions of opinions, not field-based research
or researcher observation of interactions by the participating
officers. Additionally, police officers, especially those who
have been through multicultural or bias training, may be sen-
sitive to the questions regarding mental illness stigma and
want to provide the “correct” or socially desirable answers to
questions. While we took multiple steps to ensure respond-
ent anonymity, we cannot rule out the possibility of explicit
bias. Implicit bias, however, is much more difficult to control,
as people are unaware of it, so it is more likely to become
evident when observing officer behavior (Mulay etal.2016).
Conclusion andSuggestions forFuture
Research
The current study found that CIT-trained officers felt more
prepared to handle on-duty encounters with PwMI. We also
found that the trained officers were more likely to endorse
negative stereotypes of these same individuals. Feelings of
preparedness and attitudes of mental illness are just two
of several different CIT-related outcomes identified by
Peterson and Densley (2018). Others include impacts on
dispositions, number of arrests, and incidences of use of
force. As with all police training, it is necessary to conduct
research as to whether the trainings are influential beyond
attitudes and feelings of preparedness and impacts officer
behavior. Previous research reviewing methods of implicit
bias (FitzGerald etal.2019; Forscher etal.2019; Payne and
Vuletich2018) and sexual assault (Parratt and Pina2017;
Sleath and Bull2012) training have not demonstrated a clear
pattern of translation of individual motivation and concept
comprehension to changes in behavior of training partici-
pants. Depending on the procedures utilized in training, the
focus of learning goals (for example, change in implicit bias,
changes to practiced behavior, or changes to social environ-
ment), and focused subject of bias, effects on behavior were
varied (FitzGerald etal.2019; Forscher etal.2019; Payne
and Vuletich2018). To the extent possible, future research
should focus on how elements of officer training prepare
officers for successful (or not) officer behavior in the field
when faced with PwMI.
Availability of Data and Material The datasets generated during and/or
analyzed during the current study are available from the corresponding
author on reasonable request.
Declarations
Ethics Approval The study was approved by the Stockton University
IRB.
Consent to Participate Informed consent was obtained from all study
participants.
Competing Interests The authors declare no competing interests.
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