The widespread division between mental health and criminal justice systems leads to many persons withserious mental illnesses being arrested and incarcerated when mental health treatment would be moreappropriate. The 'criminalization' of such individuals is an extensively documented problem across the U.S. Asillustrated by the Sequential Intercept Model, the most effective point of intervention within the criminal justicesystem to prevent unnecessary arrest and incarceration is the initial encounter between an officer and aperson with a serious mental illness, which is the first step in criminal justice involvement. This R34 projectseeks to implement a trial of a new police-mental health linkage system and to test its feasibility andacceptability among end-users. Our new linkage system will consist of three steps. First, some individuals whohave a serious mental illness and a history of criminal justice involvement will give special consent to allow abrief disclosure of their mental health status to be included as part of a registry in the state's criminal justiceinformation system. Second, when an officer runs an enrolled participant's name or identifiers as part of aroutine background check during an encounter, the officer will receive an electronic message that the personhas special mental health considerations, and to call a 1-800 number for more information that will connect toour Linkage Specialist. Lastly, the Linkage Specialist, who will be a certified mental health provider, will assistthe officer by thinking through observed behaviors and potential resolutions with the officer. We expect that insome cases where an arrest is not obligatory, the officer will then choose to refer to or transport to mentalhealth services instead of making an arrest because of the information provided by our straight-forward, low-cost system. Three overarching aims will guide this pilot intervention project.
In Aim A, we will implement ademonstration of the police-mental health linkage system in order to operationalize procedures and developthe protocol manual (for a larger study) through collaboration with three key partners, the Georgia Bureau ofInvestigation (which maintains Georgia's criminal justice database/information system), the Savannah-Chatham Metropolitan Police Department, and the local community mental health agency, Gateway BehavioralHealth Services.
In Aim B, we will assess all key stakeholder groups' perceptions of acceptability through focusgroups conducted with patients, patrol officers, police department leaders, and mental health services programmanagers.
In Aim C, we will demonstrate feasibility and estimate effect size and other parameters to preparefor a larger-scale study. Feasibility will be examined among 100 participants with a serious mental illness and acriminal justice history. Their number of arrests during the 1-year intervention will be compared to the prioryear, and we will assess the how many calls result in arrest versus mental health service linkage. To examinehow the linkage system worked and the ways it impacts decision-making, we will also conduct individualinterviews with officers who make use of the system, and the Linkage Specialists who take their calls.

Public Health Relevance

The public health impact of the proposed research is substantial given the national problem of criminalizationof serious mental illnesses (partly due to fragmentation between the mental health and criminal justicesystems) that translates into excessive incarceration of people with such disorders for minor infractions. Asfragmentation and resultant incarceration often delays or prevents receiving mental health treatment services;there is a dire need for improved communication and coordination between the mental health and criminaljustice sectors in order to help persons with serious mental illnesses move toward recovery. In preparation fora larger; definitive effectiveness study; in this R34 project we aim to develop and pilot test a new system-level''police-mental health linkage system;'' which may promote pre-booking jail diversion of individuals with seriousmental illnesses when appropriate.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (SERV)
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Juliano-Bult, Denise M
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Feinstein Institute for Medical Research
United States
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