CIT for Corrections: Reducing Mental Illness Stigma

Background: Estimates of serious mental illness (MI) among the prison population are as high as 16%, which exceeds estimates of MI in the general population. Despite implementation of diversion programs, the numbers of people with MI in corrections is substantial. Correctional officers (COs) are the front-line workers in correctional facilities who respond to people in crisis. COs perceive that they are not well equipped to manage situations involving people who are symptomatic. Given that COs have discretion in use of force, provision of violations, and segregation, some jails and prison in the United States are adapting the crisis intervention team (CIT) model for corrections in order to improve safety and outcomes for people with MI and officers. The aims of this research are twofold. Based on attribution theory, the first aim is to test the hypothesis that participating in CIT training decreases stigma, increases knowledge, and improves attitudes about people in prison with MI. The second aim is to explore changes in CO practices six to nine months following CIT.    

Methods: Research aims are addressed using a quasi-experimental, sequential mixed method design. Data were collected between April 2016 and April 2018. All COs enrolled in CIT training were invited to participate. 235 COs completed a pre- and/or post-survey on stigma, knowledge, and attitudes towards prisoners with MI. A randomly selected subsample of participants (n=17) completed a semi-structured interview six to nine months following CIT training. All non-CIT officers were invited to complete the same survey at one time point (n=599); a random sample of 16 non-CIT COs were selected from this pool and completed semi-structured interviews. Data were analyzed between and within groups using bivariate and multi-variate analyses. Semi-structured interviews were analyzed using Braun and Clarke’s approach to thematic analysis.   

Results: The majority of COs identified as White and male and ranged in age from 19-67 years old. CIT officers had significantly lower stigma, t(99)=4.6, p < 0.01, d=0.46, more mental health knowledge, t(94)=2.1, p=0.04, d=0.21, and better attitudes towards prisoners with MI, t(84)=2.1, p=0.04, d=0.23, following CIT training. CIT officer pre-CIT scores were not significantly different than non-CIT officer scores; however, CIT officer post-CIT scores reflected CIT officers having less stigma, t(283)=4.3, p < 0.01, d=0.38, more knowledge, t(641)=3.2, p < 0.01, d=0.31, and better attitudes, t(580)=5.1, p < 0.01, d=0.52, compared to non-CIT officers. Themes across CO interviews suggest CIT officers use new skills to de-escalate, build rapport, and refer to mental health staff despite some challenges. Non-CIT officers perceive CIT trained officers use less force. Non-CIT officers report challenges identifying mental health crises.

Conclusion and Implications: This preliminary work on CIT in prisons is promising. Additional work is needed to determine if changes in stigma, knowledge, and attitudes result in long term correctional officer behavior change and if these changes reduce negative outcomes for prisoners with mental illnesses. Results also suggest social and structural factors may impede use of CIT skills in prisons.