Serious mental illness and incarceration: piloting the use of a multi sector linked administrative dataset

项目概要/摘要 大规模监禁患有严重精神疾病的人是一场公共卫生和人权危机。 自世纪中期以来，刑事司法系统还没有在美国的犯罪行为中扮演过如此重要的角色。 社会对精神疾病的反应。自20世纪60年代末以来，研究人员注意到， 患有重度精神分裂症的囚犯，经常陷入住院、无家可归和被捕的“旋转门”。监禁 是与公共系统接触的最明显（和创伤）的时刻之一，并提供了一个窗口， 公共心理健康系统的失败我们的长期目标是告知和严格评估 政策和干预措施，旨在减少执法对精神疾病的反应， 对重度精神病患者的监禁。根据NIMH战略目标4.1B和4.2，本R34提案 进一步开发真实世界的数据收集系统，以促进研究和持续监测 与获得服务、服务连续性、公平性以及不同国家的监禁和无家可归等结果有关， 人口和环境。我们的研究方法是利用定期更新的洛杉矶县（LAC） 全县行政数据库，从2010年起将8个公共机构的个人与 目前，围绕监禁和SMI的研究。与拉丁美洲和加勒比地区管理人/提供者和非政府组织合作， LAC的研究人员，我们将通过算法开发和验证来开发和测试这个数据库， 探索导致监禁的心理健康服务模式，并测试算法， 数据集使用精神健康危机干预措施的试点评估代替执法反应， 准备R 01提案，以评估将资源从 新的和现有的精神卫生服务。作为我们的研究中心，LAC允许特别的- 由于其规模（人口> 1 000万）和跨越若干关键鸿沟的多样性， 城市/农村;种族;经济;文化;以及资源的可得性。我们的具体目标如下： 为关键措施的样本确定和操作制定算法， 在患有重度精神分裂症的服务不足人群中开展刑事司法接触和分流方案。目标2：可持续发展 通过正式的验证方法并与我们的合作伙伴协商来完善这些算法。目标3：测试 通过询问哪些类型的服务模式优先于使用链接数据集和算法进行研究的可行性 重度精神分裂症患者的监禁以及这些模式在地理和人口统计学上的差异 分组，并对替代性危机应对干预措施进行试点评价：世卫组织收到 他们的服务模式在危机服务之前和之后是什么样的，这在客户之间有什么不同 接受新的心理健康911派遣服务与联合执法心理健康危机的人 干预团队服务，以及如何将其与警方联系导致逮捕的类似客户进行比较。

Project Summary/Abstract Mass incarceration of individuals with serious mental illness (SMI) is a public health and human rights crisis. Not since the mid-nineteenth century has the criminal justice system played such a large role in how American society responds to mental illness. Since the late 1960s researchers have noted ever-rising numbers of jail inmates with SMI, often caught in a "revolving door" of hospitalization, homelessness, and arrest. Incarceration is one of the most visible (and traumatic) moments of contact with the public system, and provides a window into the failures of the public mental health system. Our long-term objective is to inform and rigorously evaluate policy and interventions that seek to reduce law enforcement response to mental illness and end the mass incarceration of individuals with SMI. In line with NIMH Strategic Objectives 4.1B and 4.2, this R34 proposal furthers the development of a real-world data collection system to facilitate research and ongoing monitoring related to access, service continuity, equity, and outcomes such as incarceration and homelessness in diverse populations and settings. Our research approach is to leverage a regularly-updated Los Angeles County (LAC) county-wide administrative database, which links individuals across 8 public agencies from 2010 to the present, for research around incarceration and SMI. In partnership with LAC administrators/providers and non- LAC researchers, we will develop and test this database through algorithm development and validation, exploration of mental health service patterns leading up to incarceration, and testing of the algorithms and dataset using a pilot evaluation of mental health crisis interventions in lieu of law enforcement response, in preparation for an R01 proposal to evaluate the effects of policies and interventions that shift resources from criminal justice to new and existing mental health services. LAC as our study site allows for a particularly in- depth look because of its size (population>10 million) and diversity across a number of critical divides: urban/rural; racial; economic; cultural; and resource availability. Our specific aims are as follows: Aim 1: Develop algorithms for sample ascertainment and operationalization of key measures to enable the study of criminal justice contact and diversion programs among underserved populations with SMI. Aim 2: Validate and refine these algorithms through formal validation methods and in consultation with our partners. Aim 3: Test the feasibility of research using the linked dataset and algorithms by asking what types of service patterns precede incarceration of individuals with SMI and how these patterns differ across geographic and demographic subgroups, and by conducting a pilot evaluation of alternative crisis response interventions: who receives them, what their service patterns look like before and after the crisis service, how this differs between clients who receive a new mental health-only 911-dispatched service vs. a joint law enforcement-mental health crisis intervention team service, and how this compares to similar clients who had a police contact leading to arrest.