Debates on current policy emphasize only one form of leverage, outpatient commitment, which is much too narrow a focus. Attempts to leverage treatment adherence are ubiquitous in serving traditional public-sector patients. Research on the outcomes associated with the use of leverage is critical to understanding the effectiveness of the psychiatric treatment system.

The Crisis intervention team model (CIT) is possibly the most well known and widely adopted model to improve police response to persons with mental illness. A primary goal of CIT programs is to divert individuals with mental illness from the criminal justice system to mental health services. In this paper we examine the effectiveness of fielding CIT trained and supported officers for influencing call outcomes using data from patrol officers (n = 112) in four Chicago Police districts. Results from regression analysis indicate that CIT certified officers directed a greater proportion of persons with mental illness to mental health services than their Non-CIT certified peers. CIT did not have an immediate effect on arrest. Moderator analysis indicates that CIT had its biggest effect on increasing direction to services and decreasing "contact only" among officers who have a positive view of mental health services and who know a person with mental illness in their personal life. Additional moderators of the CIT effect on call outcomes include level of resistance and the presence of a weapon. Findings from this study have important implications for policy, practice and future research.

Cultural differences existed among employers which supported the lay theory of mental illness.

Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.

Programs to improve police interactions with persons with mental illness are being initiated across the country. In order to assess the impact of such interventions with this population, we must first understand the dimensions of how police encounters are experienced by consumers themselves. Using procedural justice theory as a sensitizing framework, we used in-depth semi-structured interviews to explore the experiences of twenty persons with mental illness in 67 encounters with police. While participants came into contact with police in a variety of ways, two main themes emerged. First, they feel vulnerable and fearful of police, and second, the way police treated them mattered. Findings elaborate on dimensions of procedural justice theory and are informative for police practice and mental health services.