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

精神健康(MH)和刑事司法(CJ)系统之间的支离破碎导致许多人患有 严重精神疾病(SMI)被逮捕/监禁，而MH治疗更合适。 对这些人的“刑事化”是一个在美国各地广泛记录的问题。 顺序拦截模型，CJ系统内防止不必要的主要干预点 逮捕/监禁是警官和患有SMI的人之间的首次接触。这项R01研究旨在 测试新的警察-MH联动系统的有效性，该系统通过先前的NIMH R34项目展示 实施和研究的可行性，并在最终用户中具有较高的接受度。我们的联动系统 由3个步骤组成。首先，有SMI和CJ涉案历史的个人特别同意 包括在该州CJ信息系统的数据库中，并同意警官拥有电话 与当地公共MH系统的链接专家交谈，他们正在或曾经在那里接受治疗。 第二，当官员在查询过程中运行登记参与者的姓名或标识时(类似于 背景调查)在一次遭遇中，警官收到一条电子消息，表明此人在MH 治疗，并拨打电话了解更多信息。第三，联系专家，他是一名有执照的MH 专业人士，接到电话并通过思考观察到的行为和潜力来协助警官 决心。R34调查结果表明，在某些情况下，当逮捕不是强制性的时，警官选择 提交或运送到MH服务机构，而不是进行逮捕(在许多情况下，主题是 重新连接到CARE)，因为提供的信息。与我们的CJ合作伙伴佐治亚州局合作 调查(佐治亚州CJ数据库/信息系统)以及4个公共卫生部 我们将在佐治亚州的25个县进行一项涉及1600人的连锁系统的随机试验 门诊SMI患者。我们将检验患者随机进入链接系统的假设(作为比较 对于那些随机进入不生成MH通知和电话号码的数据库的人)将：(1)较少 可能被逮捕，(2)逮捕人数较少(根据GBI提供的行政(前科)数据)， 以及(3)不太可能出现门诊MH服务的缺口，这从缺席护理的人数减少就是明证。 月数(根据卫生署各机构EMR的数据)。我们将检查4个潜在的主持人的效果： 城市与农村患者部位，男性与女性患者，精神病患者与情绪障碍患者，较低患者与较高患者。 逮捕的可能性(根据根据年龄调整的终生逮捕史)。一旦患者登记参加 联动系统，它的机制是直截了当的，2个关键目标是可验证的。也就是说，我们将展示 目标1(对数据库的电子“命中”)和目标2(接到电话的链接专家) 订婚了。联动系统在以下情况下将不会产生效果(减少逮捕和门诊MH服务缺口) 这两个可验证的事件不会发生。如果证明有效，我们将为其他司法管辖区准备一个工具包。

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.