The Crisis Intervention Team (CIT) model has become the nation’s leading example of a positive use of the intersection between the criminal justice system and the psychiatric emergency system. The CIT model is the predominant model of law enforcement–based community intervention for individuals experiencing a behavioral crisis. The psychiatric emergency service (PES) provides a natural partnership with the CIT model in that it has the unique ability to work closely with other medical emergency services and trauma centers. This gives the PES a major role in the reintegration of those experiencing a crisis event related to a mental illness into a mainstream approach to health care. The CIT model challenges the PES to bring expertise in community psychiatry, emergency treatment, and general medical care together in an integrated format. This model of crisis intervention requires the PES to work in partnership with law enforcement and advocates. CIT also needs a cooperative system of care involving community mental health, substance abuse, and social service providers. Alternative approaches to law enforcement–related crisis intervention tend to make a minimal impact on the flow of individuals through the mental health system. Such alternative approaches tend to direct individuals experiencing a psychiatric emergency into treatment options in which psychiatric and general medical emergency care have a secondary or consultative role.

The partnership between the Crisis Intervention Team model and the PES relies on a series of building blocks, among which is a comprehensive relationship with the community that becomes a part of the standard operating procedure of the PES. The relationship with the community has to be ongoing and should include a cooperative structure able to influence a variety of community processes. The structure will often take the form of a community task force with a wide range of membership, including advocates, family members, and individuals with mental illness. Law enforcement, most particularly the police department, is a key partner in the task force. The third partnership involves providers and administrators from mental health, substance abuse, and social services systems of care. Finally, representatives from government, corrections, and the judiciary often serve important roles on the task force.

Engagement with the community results in a direct involvement with public policy and funding priorities. The model will result in the implementation of law enforcement–based training, the development of cooperative patient referral strategies, and the establishment of a feedback mechanism that addresses the ability of the ser-vice delivery system to meet community needs. Community needs include clinical outcomes such as the emergency service’s accessibility to referring law enforcement agencies, the ability of the emergency service to access appropriate disposition resources (inpatient and community mental health treatment) in a timely manner, and the level of patient and advocate satisfaction.

The CIT system of community-based crisis intervention makes some basic demands on the physical plant and staff of the PES. First, a PES needs the capacity to respond to individuals presenting with complex symptomatology and a wide range of impulsive or disorganized behaviors. Second, the PES should include adequate physical space with a logical layout that can accommodate multiple police offers arriving with patients at the same time. This will allow the ser-vice to receive individuals who are in need of involuntary treatment and see them in a safe area, while those arriving for voluntary treatment can make use of a waiting room. Third, the service must address the needs of a person who will require a significant level of intervention, including the possible need for seclusion and restraint.

A PES requires not only physical space, but also staff with the ability to provide adequate care for this patient population. Staff must have the diagnostic expertise necessary to make complex triage decisions, as well as the willingness to take a team approach when faced with individuals with substantial clinical needs, limited resources, and a wide range of disposition requirements. The demands that a community-based CIT program makes on a PES are substantial. As a result, ongoing administrative support is essential. Although the CIT model can be challenging, once this commitment is made, law enforcement, advocates, and government itself become strong advocates for emergency mental health care. Through the implementation of the CIT model of community-based crisis intervention, the PES can provide an intersection point for integrated health care and a primary point of entry for diverting individuals experiencing a mental illness crisis event away from the criminal justice system and into the health care system.