Crisis Intervention Team Training in Jails
Richard Forbus, MBA-HCM, CCHP, and Claire Wolfe, MPH, MA, CCHP
It is highly unlikely that anyone working in law enforcement today is unfamiliar with the Crisis Intervention Team model, commonly referred to as “CIT.” First established in 1988 by the Memphis Police Department, following a 1987 officer-involved shooting of a subject in crisis who was wielding a knife, the “Memphis Model” has long been known as the gold standard for law enforcement crisis intervention programs in the United States.
Establishing the first CIT program model was a critical step toward improved training and awareness among law enforcement of mental health issues and needs. Nearly 40 years after the Memphis incident, CIT program training has become the rule, not the exception, in law enforcement. Although originally focused on patrol functions, CIT programs have been adapted for and now are a critical component of training and education for jail staff.
Why CIT Programs Are Essential in Jails
In the community, CIT programs are effective at mitigating risk and improving outcomes for officers and people with mental illness who encounter law enforcement, but they are essential in jails.
Compared to just a few decades ago, there is increased recognition of the role jails play in housing and treating individuals with mental health conditions and substance use disorders. It is common for individuals who are withdrawing from substances or suffering from untreated mental health conditions to be housed in jail as their case makes its way through the criminal justice system.
Ideally, individuals with mental health conditions, a history of trauma, and/or substance use disorders would be supported and receiving care in the community before they are in a situation that leads to incarceration. However, community mental health resources are limited in many states and communities, availability is often minimal, and space is typically reserved for those in crisis. In other words, the system in the community is driven toward a crisis model.
Untreated mental health conditions and a lack of support can lead to negative outcomes, including decompensation, substance use to self-medicate, instability in work and relationships, and a plethora of other unsustainable situations that increase the likelihood and frequency of contact with law enforcement. The downstream effect of inaccessible community-based mental health care is that many will end up incarcerated at least once.
A typical progression starts with nuisance type crimes, such as trespassing, disorderly conduct, or public intoxication, and short stays in jail. Over time, and through repeated recidivism, some individuals progress from a simple misdemeanor to a felony offense that may range from the possession of a controlled substance charge to a crime where there is a victim, which may include property or violent crimes. Individuals then stay in custody longer, and the opportunity for early intervention has passed.
In 1999, the United States Department of Justice (DOJ) recognized the emerging challenges that correctional facilities faced due to the increased number of individuals with mental health conditions in custody. At that time, the DOJ published a report estimating that 16% of individuals held in jail or prison were classified as “mentally ill.” It is difficult to find a current, nationally representative estimate, however, many working in jails today would consider that percentage low. Some facilities we have worked with have populations in which 60% or more receive treatment for a mental health, substance use, and/ or a chronic health condition. It is common to have a co-occurrence of multiple medical and mental health issues that are untreated at the time of arrival at a jail intake.
The purpose of a jail, first and foremost, is to provide a secure environment. Jails are not designed to serve as mental health and substance use treatment facilities. Challenges in providing such care within the facility include limitations in facility design and staffing to offer therapeutic care, drawn out court processes (including competency restoration processes), and unpredictable release dates that inhibit discharge planning efforts to ensure continuity of care.
Despite these challenges, the jail is expected to maintain custody and care of individuals with high acuity and high needs for care. For those who have worked in jails, it is no surprise to see the same individuals in crisis on a continual basis, and it is a source of frustration. Jails inherit all the risk of dealing with patients with high needs but are not always given the resources they need to manage the patients they receive. Further, patients retain the right to refuse care, which is often a factor in adverse outcomes, even when a jail has an excellent system of care. In many communities, jails are the de-facto mental health treatment facilities, and, in the absence of systemic changes in the health care system, they must be prepared to assume that responsibility.
The jail environment is essentially “ground zero” where these factors all come together. The challenge that jails face comes in the form of elevated risks of adverse medical events, elevated risks of self-harm, potential use of force events, injuries to staff, injuries to people in custody, and the litigation and liability associated with these issues. Mitigating risk starts with identifying and recognizing the potential issue(s), changing policy and practice, data collection and measurement, continuous quality improvement, and utilizing a risk management and mitigation approach to the operation as a whole—and of course, training.
CIT training equips correctional officers with essential knowledge, skills, and confidence to identify and verbally de-escalate psychiatric crises among those in custody. Curriculum may include factual information about mental illness, substance use disorders, and gender and trauma-informed care, among other topics, as well as hands-on, simulated learning of various de-escalation techniques. Now more than ever, jail staff need to be supported with training and resources to provide effective services and care. The high acuity and risk, combined with the constitutional requirement to provide care, mean communities should be engaging with the jails just as eagerly as jails seek assistance. CIT is a program that should be a major component of the training and resources for staff.
The Benefits of CIT Training in Jails
Correctional staff are the eyes and ears of the day-to-day 20 | QUARTER 1 2026 AMERICANJails Conclusion operation. They are often the f irst to see someone’s behavior change, someone with a mental health history who has started decompensating, or a medical emergency or mental health crisis as it emerges. In those first few moments, staff response can be a determining factor in the outcome.
Prior to the implementation of CIT in correctional facilities, someone in crisis was typically met with some sort of force to gain immediate control of the individual. Tactics could range from open-hand restraint control techniques to less-than-lethal options. Depending on the facility and agency, tools such as handcuffs, OC spray, electronic control devices, inmate restraint chairs, or a tactical team using less-than-lethal munitions may have been an option. In some agencies, officers may have the ability to carry and use such tools, while other agencies may require a supervisor to respond and employ them or to approve their use prior to application. Unfortunately, the reliance on force without a crisis intervention approach has resulted in injuries for people in custody and/or staff, in-custody deaths, and other adverse outcomes.
A critical component of the crisis intervention model is collaboration across the custody, medical, and mental health disciplines. Effective communication and collaborative relationships can mitigate the need to use force and contribute to achieving a safe outcome. Since their implementation, CIT programs have created a culture where a person in crisis is recognized and efforts are made to de-escalate the situation, versus a primary reliance on physical restraint or other force applications. CIT programs enhance communication and collaboration, prevent unnecessary use of force and injuries, and ultimately make our facilities safer for staff and those under our custody and care.
Additionally, CIT programs can be useful in evaluating the community’s impact on jail utilization, recidivism, and outcomes. Establishing a comprehensive CIT program requires the development of effective partnerships with public health providers and the community to ensure communication of needs and continuity of care once someone is released from custody. These relationships can open the door to additional resources and funding but can also create an opportunity for the community to see the commitment that jail staff demonstrate in working with those in custody.
An Opportunity
Highlighting the needs of people in custody and taking action to improve the day-to-day life of those with mental health conditions, substance use disorders, and a history of trauma are sorely needed. In practice, we urge readers to have open discussions about these topics, without judgement, and to use CIT training as an opportunity to engage, learn, and exchange thoughts about this topic. Themes may emerge that warrant attention by leadership.
Correctional officers disproportionately experience mental health issues and trauma, relative to the general population, due to the nature of the job. This must be acknowledged when discussing the needs of the incarcerated population. In addition to training for staff, this is an opportunity to better understand their needs and experiences. Connections to confidential, accessible services where staff can receive support and treatment should be made available. Preventing burnout and trauma among correctional staff is crucial to taking care of those in custody.
Conclusion
In addition to the benefits to jails and their staff, effective CIT programs have enhanced community relationships with public health and private providers by strengthening continuity of care processes. In many cases, the partnership between the facility, its correctional health care staff, and the community allows for care to be coordinated, which can prevent or reduce crime, reduce recidivism for individuals who may not otherwise get care, and make communities safer.
Widespread CIT training has not only changed the thinking of the “why” behind the individual being in crisis, but has transformed the response. The knowledge and skills taught in CIT training enhance correctional officers’ abilities to safely and calmly respond to individuals in crisis, reducing physical injuries and mitigating emotional harm.
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Richard Forbus, MBA, CCHP, is the vice president of program development for the National Commission on Correctional Health Care (NCCHC), where he assists custody and health administrators in improving their delivery of correctional health care services. He retired as a corrections captain after 25 years of service with the Las Vegas Metropolitan Police Department and is a United States Marine Corps veteran, where he served as a corrections specialist. He can be reached at richardforbus@ncchc.org
Claire Wolfe, MA, MPH, CCHP, is a program manager at NCCHC Resources, Inc., NCCHC’s consulting subsidiary. Ms. Wolfe brings a diverse skill set in data collection and analysis, advocacy, and program management to NCCHC Resources. Reach her at clairewolfe@ncchcresources.org
References
Bureau of Justice Statistics. (1999). Mental health and treatment of inmates and probationers (NCJ 174463). U.S. Department of Justice, Office of Justice Programs. https://bjs.ojp. gov/content/pub/pdf/mhtip.pdf