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

精神卫生（MH）和刑事司法（CJ）系统之间的分裂导致许多人 严重精神疾病（SMI）被逮捕/监禁时，MH治疗将更合适。 对这些人的“刑事定罪”是美国各地广泛记录的一个问题。 序贯拦截模型，CJ系统内的主要干预点，以防止不必要的 逮捕/监禁是警官与重度精神创伤患者之间的初次接触。本R 01研究旨在 测试一个新的警察-卫生部联系系统的有效性，通过以前的NIMH R34项目，显示 实施和研究是可行的，并在最终用户中具有较高的可接受性。我们的联动系统 由三个步骤组成。首先，患有SMI和CJ参与史的个人特别同意 包括在该州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系统的联系专家交谈。 第二，当官员运行登记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，警官收到一条电子信息，表明该人在MH 治疗，并拨打一个号码以获取更多信息。第三，联动专家，谁是持牌MH 专业人员，接到电话，通过思考观察到的行为和潜力来协助警官 决议。R34调查结果表明，在某些情况下，当逮捕不是强制性的，官员选择 转介或运送到卫生部服务，而不是进行逮捕（在一些情况下，主题是 重新连接到护理），因为提供的信息。与我们的CJ合作伙伴，格鲁吉亚局合作， 调查（其中包含格鲁吉亚的CJ数据库/信息系统），以及4个公共卫生机构 覆盖格鲁吉亚的25个县，我们将进行一项涉及1600名 SMI的门诊患者。我们将检验随机分配到连锁系统的患者（与 随机分配到不生成MH通知和电话号码的数据库的那些人）将：（1）更少 可能被逮捕，（2）逮捕人数较少（均基于GBI提供的行政（犯罪记录）数据）， 以及（3）门诊MH服务不太可能存在缺口，这一点可以通过>3的缺席人数减少来证明 月（根据卫生部机构的电子病历数据）。我们将研究4个潜在调节器的效果： 城市与农村患者地点，患者的男性与女性，精神病患者与心境障碍，以及较低与较高 被捕的可能性（根据年龄调整的终生被捕史）。一旦患者入组 联动系统，其机制是简单的，和2个关键目标是可验证的。也就是说，我们将证明， 目标1（对数据库的电子“命中”）和目标2（联系专家接到电话）是 订婚了在下列情况下，联系系统不会产生效果（减少逮捕和门诊MH服务缺口）： 这两个可证实的事件没有发生。如果证明有效，我们会为其他司法管辖区准备一套工具包。

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.