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; 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）与刑事司法（CJ）系统之间的分裂导致许多人 当MH治疗更合适时，严重的精神疾病（SMI）被捕/监禁。 此类人的“犯罪”是美国在美国的广泛记录的问题 顺序截距模型，是CJ系统中干预的主要点，以防止不必要 逮捕/监禁是军官与SMI的人之间的最初相遇。这项R01研究旨在 测试新的警察 - MH链接系统的有效性，该系统通过先前的NIMH R34项目显示了 可以实施和学习，并在最终用户中具有很高的可接受性。我们的链接系统 由3个步骤组成。首先，具有SMI和CJ参与史的个人给予特别同意 包括在该州CJ信息系统中的数据库中，并同意官员有电话 与当地公共MH系统或正在接受治疗的当地公共MH系统的连锁专家对话。 其次，当一名官员运行注册的参与者的姓名或标识符时，作为查询的一部分（类似于 背景调查）在遭遇期间，该官员收到一条电子信息，即该人在MH中 处理，并致电一个电话以获取更多信息。第三，连接专家，他是持牌MH 专业人士，接收电话，并通过观察的行为和潜力来思考官员 决议。 R34调查结果表明，在某些情况下，当逮捕没有强制性时，该官员选择 参考或运输到MH服务而不是逮捕（在许多情况下，受试者是 由于提供的信息而重新关注）。与我们的CJ合作伙伴佐治亚局合作 调查（佐治亚州的CJ数据库/信息系统）以及4个公共MH机构 在佐治亚州覆盖25个县，我们将对涉及1,600的连锁系统进行随机试验 带有SMI的门诊病人。我们将测试患者随机与连锁系统的假设（比较 对于那些随机到未生成MH通知和电话号码的数据库的人）将：（1）较小 可能被捕，（2）逮捕较少（均基于GBI提供的行政（说唱表）数据）， （3）在门诊MH服务中差距差距较小，这证明了少于3的护理> 3 月（根据MH机构EMR的数据）。我们将检查4个潜在主持人的效果： Urban诉Rough患者网站，男性诉患者的女性，精神病诉情绪障碍，较低v。 逮捕的可能性（基于根据年龄调整的逮捕历史）。一旦患者入学 链接系统，其力学很简单，可验证2个关键目标。也就是说，我们将证明 目标1（数据库的电子“命中”）和目标2（接收呼叫的链接专家）是 已订婚的。连锁系统不会产生效果（减少逮捕和门诊MH服务差距） 这两个可验证的事件不会发生。如果被证明有效，我们将为其他司法管辖区准备一个工具包。