A Trial of a Police-Mental Health Linkage System for Jail Diversion and Reconnection to Care

警察与心理健康联动系统的尝试，用于监狱转移和重新获得护理

• 批准号: 10757245
• 负责人: MICHAEL T COMPTON
• 金额: $ 12.77万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10757245
• 关键词: Age; Behavior; Caring; Communication; Consent; County; Criminal Justice; Data; Databases; Disease; Electronics; Enrollment; Event; Female; Funding; Health Professional; Health system; Imprisonment; Individual; Information Systems; Intercept; Intervention; Investigation; Jail; Licensing; Mechanics; Mental Health; Mental Health Services; Minor; Modeling; Mood Disorders; Names; National Institute of Mental Health; Outpatients; Patients; Persons; Police; Public Health; Randomized; Recording of previous events; Recovery; Research; Resolution; Running; Site; Specialist; System; Telephone; Testing; Thinking; Translating; acceptability and feasibility; effectiveness testing; improved; male; participant enrollment; prevent; psychotic; randomized trial; rural patients; service gap; severe mental illness; sex; treatment services

Fragmentation between mental health (MH) and criminal justice (CJ) systems leads to many persons with serious mental illnesses (SMI) being arrested/incarcerated when MH treatment would be more appropriate. The “criminalization” of such individuals is an extensively documented problem across the U.S. As shown by the Sequential Intercept Model, the main point of intervention within the CJ system to prevent unnecessary arrest/incarceration is the initial encounter between an officer and a person with SMI. This R01 study aims to test the effectiveness of a new police–MH linkage system that, through a prior NIMH R34 project, was shown to be feasible to implement and study, and to have high acceptability among end-users. Our linkage system consists of 3 steps. First, individuals with SMI and a history of CJ involvement give special consent to be included in a database in the state’s CJ information system, and consent for an officer to have a telephone conversation with a Linkage Specialist at the local public MH system where they are or were in treatment. Second, when an officer runs an enrolled participant’s name or identifiers as part of an inquiry (similar to a background check) during an encounter, the officer receives an electronic message that the person is in MH treatment, and to call a number for more information. Third, the Linkage Specialist, who is a licensed MH professional, receives the call and assists the officer by thinking through observed behaviors and potential resolutions. R34 findings indicated that in some cases when an arrest is not obligatory, the officer chose to refer to or transport to MH services instead of making an arrest (and in a number of cases the subject was reconnected to care) because of the information provided. Partnering with our CJ partner, Georgia Bureau of Investigation (which houses Georgia’s CJ databases/information system), as well as 4 public MH agencies covering 25 counties in Georgia, we will conduct a randomized trial of the linkage system involving 1,600 outpatients with SMI. We will test the hypotheses that patients randomized to the linkage system (as compared to those randomized to a database that does not generate the MH notice and phone number) will: (1) be less likely to be arrested, (2) have fewer arrests (both based on administrative (rap sheet) data provided by GBI), and (3) be less likely to have gaps in outpatient MH services, as evidenced by fewer absences from care of >3 months (based on data from the MH agencies’ EMRs). We will examine effects of 4 potential moderators: urban v. rural patient site, male v. female sex of the patient, psychotic v. mood disorder, and lower v. higher likelihood of arrest (based on lifetime history of arrests adjusted for age). Once a patient is enrolled into the linkage system, its mechanics are straightforward, and 2 key targets are verifiable. That is, we will show that Target 1 (an electronic “hit” to the database) and Target 2 (the Linkage Specialist receiving a call) were engaged. The linkage system will not produce effects (reducing arrests and outpatient MH services gaps) if these 2 verifiable events do not occur. If proven effective, we will prepare a toolkit for other jurisdictions.

心理健康（MH）和刑事司法（CJ）系统之间的分裂导致许多人患有 当 MH 治疗更合适时，严重精神疾病 (SMI) 被逮捕/监禁。 对此类个人的“定罪”是美国各地广泛记录的问题，如下所示 顺序拦截模型，CJ系统内的主要干预点，以防止不必要的 逮捕/监禁是警官和 SMI 患者之间的初次接触。本 R01 研究旨在 测试新的警察与 MH 联动系统的有效性，该系统通过之前的 NIMH R34 项目得到了证明 实施和研究可行，并在最终用户中具有较高的可接受性。 包括 3 个步骤，首先，患有 SMI 且有 CJ 参与历史的个人特别同意。 包含在州 CJ 信息系统的数据库中，并同意官员拥有电话 与他们正在或曾经接受治疗的当地公共 MH 系统的联动专家进行对话。 其次，当官员将登记的参与者的姓名或标识符作为查询的一部分时（类似于 背景调查）在遭遇过程中，警官会收到一条电子消息，表明此人处于 MH 状态 治疗，并拨打电话以获取更多信息。 第三，联系专家，他是有执照的 MH。 专业，接听电话并通过思考观察到的行为和潜力来协助警官 R34 调查结果表明，在某些情况下，当逮捕不是强制性的时，警官会选择逮捕。 转介或送往 MH 服务机构，而不是进行逮捕（在许多情况下，对象是 重新连接到护理）因为所提供的信息与我们的 CJ 合作伙伴佐治亚州局合作。 调查（包含佐治亚州的 CJ 数据库/信息系统）以及 4 个公共 MH 机构 覆盖佐治亚州25个县，我们将进行联动系统的随机试验，涉及1,600人 我们将检验 SMI 门诊患者随机分配到联动系统的假设（作为比较）。 对于那些随机分配到不生成 MH 通知和电话号码的数据库的人）将： (1) 更少 可能被逮捕，(2) 被捕人数较少（均基于 GBI 提供的行政（犯罪记录表）数据）， (3) 门诊 MH 服务出现缺口的可能性较小，如超过 3 人的缺勤情况较少就证明了这一点 个月（基于 MH 机构的 EMR 数据）我们将检查 4 个潜在调节因素的影响： 城市与农村患者地点、患者的男性与女性、精神病患者与情绪障碍以及较低与较高 逮捕的可能性（根据根据年龄调整的终生逮捕史）。 联动系统，其机制很简单，并且有两个关键目标是可验证的，也就是说，我们将证明这一点。 目标 1（对数据库进行电子“点击”）和目标 2（接到电话的联动专家） 如果参与的话，联动系统不会产生效果（减少逮捕和门诊 MH 服务缺口）。 如果这两个可验证的事件没有发生，我们将为其他司法管辖区准备一个工具包。

项目成果

Information sharing across mental health service providers and criminal legal system stakeholders: Perspectives of people with serious mental illnesses and their family members.

• DOI: 10.1016/j.socscimed.2022.115178
• 发表时间: 2022-06
• 期刊: Social science & medicine
• 影响因子: 5.4
• 作者: Leah G. Pope;Amanda Warnock;Tyler Perry;Stephanie Langlois;Simone Anderson;Tehya Boswell;P. Appelbaum;L. Dixon;A. Watson;M. Compton