CIT & MH Service Access in Police Contacts: Impact on Outcomes of Persons w/SMI

描述(由申请人提供)：美国正处于一个严重的公共卫生问题之中，这与逮捕和监禁患有严重精神疾病的个人有关，同时刑事司法环境中的精神健康治疗不足。该应用程序旨在检查变异性在提供/获得妇科保健服务方面的作用，因为它们与广泛实施的执法和心理健康之间的合作危机干预小组(CIT)模式有关。CIT可以被认为是一种提前预约监狱改道的形式，便于转介到精神健康服务系统。虽然各城市和各州都有精神健康服务的一些安排(如不拒绝政策和优先向警察转介的个人)(这些是CIT模式的核心要素)，但它们提供的服务往往不同，大多数仅限于紧急治疗和急性病例的稳定。拟议的研究将解决精神健康干预和服务研究中的一个关键知识缺口，因为很少有研究探讨精神健康服务可获得性对CIT有效性的作用，特别是在安全性、精神健康服务的利用和参与以及患有严重精神疾病的个人参与刑事司法系统方面。将检查芝加哥所有25个警区在接入和服务可用性方面的差异。这项研究将解决一个 一个悬而未决的问题是，更多地获得精神卫生服务在多大程度上足以减少警官遇到精神疾病患者时的逮捕，以及对警官的专门培训在多大程度上增加了这种获得作为一种转移注意力的方法的有效性。将利用对警察进行的全面评估、对患有严重精神疾病并最近与执法部门有过接触的个人进行基线和纵向后续评估，以及对这两个群体的成员和其他主要告密者进行深入访谈等方法来实现该项目的目标。具体目标是：(1)评估CIT培训对不同服务可获得性的不同警区的精神健康相关呼叫(逮捕、与精神健康服务的联系或仅限接触)的即时结果的影响；(2)确定这些即时结果以及CIT的反应、接触安排和精神健康服务的可获得性如何影响12个月期间精神病患者的长期结果和服务利用；以及(3)描述警察通过警官、消费者和其他关键个人的经历和他们持有的看法将个人与精神健康服务联系起来的可及性。第二个目标将探讨地理位置(通过空间制图)与精神科服务可获得性、社区特征、 所接电话和主题的特征、近期结果和长期结果。 与公共健康相关：由于与执法人员和刑事司法系统接触的精神疾病患者数量惊人地高，而且危机干预小组(CIT)计划在美国各地的迅速采用，迫切需要了解CIT在什么条件下能够改善这些人的结果。这项研究在概念和方法上的创新包括：(1)25个警区的研究集中于精神卫生服务可获得性的差异，以探索对服务利用和精神健康和刑事司法结果的影响；(2)独特且经济高效的呼叫识别系统，以获得有效和可靠的接触水平数据；以及(3)整合来自定量和定性调查领域的假设驱动的方法，包括空间/地理分析，以了解CIT如何以及在什么条件下在一般人群中有效。鉴于执法/刑事司法与心理健康之间存在的问题的严重性，这项拟议的研究势必会对公众健康产生重大影响。

DESCRIPTION (provided by applicant): The United States is in the midst of a serious public health problem pertaining to the arrest and incarceration of individuals with serious mental illnesses, in conjunction with an inadequacy of mental health treatment in criminal justice settings. This application aims to examine the role of variability in availability of/access to menal health services as they relate to the widely implemented Crisis Intervention Team (CIT) model of collaboration between law enforcement and mental health. CIT can be considered a form of pre- booking jail diversion that facilitates referral to the mental health services system. While some arrangements with mental health services (such as a no-refusal policy and priority to police-referred individuals) exist across cities and states (these being among the core elements of the CIT model), they often differ in the services provided, and most are limited to emergency treatment and stabilization of acute cases. The proposed research will address a critical knowledge gap in mental health intervention and services research, as little research has examined the role of mental health service accessibility on the effectiveness of CIT, especially in terms of safety, mental health service utilization and engagement, and criminal justice system involvement of individuals with serious mental illnesses. Differences in access and service availability will be examined across all 25 Chicago police districts. This research will address an open question of the extent to which greater access to mental health services is sufficient to reduce arrests when officers encounter individuals with mental illnesses, and the extent to which specialized training of officers adds to how effective that access is as a method of diversion. Methods such as cross-sectional assessments with police officers, baseline and longitudinal follow-up assessments with individuals who have serious mental illnesses and have had a recent encounter with law enforcement, and in-depth interviews with members of these two groups and other key informants, will be utilized to achieve the project's aims. The specific aims are to: (1) estimate the impact of CIT training on immediate outcomes of mental health-related calls (arrest, linkage to mental health services, or contact only) across police districts with varying service accessibility; (2) determine how these immediate outcomes, as well as CIT response, access arrangements, and availability of mental health services affect longer-term outcomes and utilization of services among individuals with mental illnesses over a period of 12 months; and (3) describe how accessible it is for officers to connect individuals with psychiatric services through both experiences that officers, consumers, and other key individuals have had and the perceptions they hold. A secondary aim will explore the connection between geographic location (via spatial mapping) and psychiatric service accessibility, characteristics of community, characteristics of calls received and subjects, immediate outcomes, and longer- term outcomes. PUBLIC HEALTH RELEVANCE: Because of the remarkably high number of persons with mental illnesses who have encounters with law enforcement officers and the criminal justice system, and the rapid adoption of Crisis Intervention Team (CIT) programs across the United States, there is an urgent need to understand under what conditions CIT leads to improved outcomes for such individuals. Innovation in both the conception and methodology of this research include: (1) a 25 police district study focused on differences in mental health services availability to explore effect on service utilization and mental health & criminal justice outcomes (2) a unique and cost-effective system of identification of calls to obtain valid and reliable encounter-level data; and (3) the integration of hypothesis-driven methodologies drawn from the quantitative and qualitative fields of inquiry, including spatial/geographic analysis, in order to understand how and under what conditions CIT is effective across generalizable populations. Given the magnitude of the problems at the interface between law enforcement/criminal justice and mental health, the proposed study is poised to have a major public health impact.