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，涉及逮捕和监禁患有严重精神疾病的个人，以及刑事司法环境中精神健康治疗的不足。此应用程序的目的是检查的作用的可变性提供/获得menal健康服务，因为它们涉及到广泛实施的危机干预小组（CIT）的执法和心理健康之间的合作模式。CIT可以被认为是一种预约监狱分流的形式，便于转介到精神卫生服务系统。虽然各城市和各州都有一些精神卫生服务安排（如不拒绝政策和优先考虑警方转介的个人）（这些都是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。拟议的研究将解决心理健康干预和服务研究中的关键知识差距，因为很少有研究探讨心理健康服务可及性对CIT有效性的作用，特别是在安全性，心理健康服务利用和参与以及严重精神疾病患者参与刑事司法系统方面。访问和服务可用性的差异将在所有25个芝加哥警区进行检查。这项研究将解决一个 在多大程度上增加获得精神健康服务的机会足以减少警察遇到精神病患者时的逮捕，以及在多大程度上对警察进行专门培训以增加获得精神健康服务作为一种转移方法的有效性，这是一个悬而未决的问题。 为实现该项目的目标，将采用各种方法，如对警官进行横向评估，对患有严重精神疾病和最近曾与执法部门有过接触的个人进行基线和纵向跟踪评估，以及对这两个群体的成员和其他关键举报人进行深入访谈。具体目标是：（1）估计CIT培训对心理健康相关呼叫的即时结果的影响（逮捕、与精神卫生服务联系或仅接触），服务可及性各不相同;（2）确定这些直接结果以及CIT响应、访问安排，心理健康服务的可用性影响更长时间-精神疾病患者在12个月内的长期结果和服务利用情况;以及（3）描述官员如何通过官员，消费者，以及其他关键人物的看法。第二个目标是探索地理位置（通过空间映射）和精神病服务可及性，社区特征， 接收的呼叫和受试者的特征、即时结果和长期结果。 公共卫生相关性：由于与执法人员和刑事司法系统有接触的精神疾病患者数量非常多，而且美国各地迅速采用了危机干预小组（CIT）计划，因此迫切需要了解在何种条件下CIT会改善这些人的结果。本研究在概念和方法上的创新包括：（1）一项25个警区的研究，重点关注心理健康服务可用性的差异，以探索对服务利用以及心理健康和刑事司法结果的影响（2）独特且具有成本效益的呼叫识别系统，以获得有效且可靠的遭遇级数据;以及（3）整合来自定量和定性研究领域的假设驱动方法，包括空间/地理分析，以了解CIT如何以及在何种条件下在可推广的人群中有效。鉴于执法/刑事司法和精神健康之间的接口问题的严重性，拟议的研究将产生重大的公共卫生影响。

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.