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Background and Purpose: An estimated 25-30 percent of detainees at Chicago’s Cook County Jail experience some form of mental illness as cited by the Cook County Sheriff, Thomas Dart. The closures of two Chicago inpatient facilities, six mental health clinics, and several other mental health services in Chicago since 2009 likely contribute to these high rates.
As police officers are often first responders to individuals experiencing a mental health or behavioral crisis, Crisis Intervention Teams (CIT) among other interventions were developed to train voluntary officers to safely respond and to connect these individuals to mental health services when appropriate. This process involves interorganizational implementation of multiple emergency response professionals.
Evaluation research has been conducted to assess the effectiveness and outcomes of police response to individuals experiencing a mental health or behavioral crisis. However, there has been little focus on evaluating the process of interorganizational policy implementation. This qualitative analysis examines the process of interorganizational policy implementation and the street-level discretion experienced by responding officers, dispatchers, mental health providers, and paramedics to provide appropriate interventions to individuals experiencing a mental health or behavioral crisis.
Methods: Twenty-eight respondents participated in in-depth, semi-structured interviews and focus groups addressing emergency response to individuals experiencing a mental health or behavioral crisis. Procedures for selecting the sample included purposeful sampling to select cases that are information rich and pertinent to the questions asked. The target sample includes professional stakeholders who are involved with the process through which a person with mental illness becomes involved with the criminal justice system including Chicago police officers (CIT-trained and non-CIT-trained), emergency medical technicians, paramedics, dispatchers and mental health professionals.
With the exception of one focus group which declined recording, all interviews were audio-recorded. Topical transcriptions were formed from both the audio recordings and interview/observational notes and the interviews and notes were coded into thematic categories in NVIVO software and further condensed into sub-themes through the iterative analysis process.
Findings: The findings from this study reveal themes of interorganizational implementation challenges in data collection, policy and practice, communication, manpower and resources, and hand-offs to hospitals. In particular, emergency responders described their methods of using discretionary decision making in executing policy at the street-level to address these implementation challenges. For example, the findings suggest that police officers and dispatchers will apply specific interventions to particular situations or people which may bypass standing policy to provide a more comprehensive intervention.
Conclusions and Implications: This analysis shows that street-level emergency responders have valuable knowledge at the street level which contribute to situation and individual specific interventions that sometimes oppose organizational policy. Implementation research has acknowledged that policy does not always mandate what matters to the outcomes at the local level. This divergence from policy to practice at the local level increase when the intervention involves multiple organizations. The findings in this analysis reveal the important role of the street-level emergency responder in policy formation specifically pertaining to the formation of interorganizational implementation policies.