The ?criminalization? of persons with serious mental illnesses (SMI) is an extensively documented problem across the U.S. Our ongoing R01 is testing the effectiveness of a new police?mental health (MH) ?Linkage System? that, through a prior NIMH R34 project, was shown to be feasible to implement and acceptable to end- users. The Linkage System consists of 3 steps. First, individuals with SMI and a history of criminal justice (CJ) involvement give special consent to be included in a database in the state?s CJ information system, and consent for CJ personnel to have a telephone conversation with a Linkage Specialist at the local public MH system where they are in treatment. Second, when an officer runs an enrolled participant?s name or identifiers as part of an inquiry / 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. In some cases when an arrest is not obligatory, the officer may choose to refer to or transport to MH services instead of making an arrest (and in a number of cases the individual is 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), and 4 public MH agencies covering 25 counties in Georgia, we are conducting a randomized trial of the Linkage System involving 1,600 outpatients with SMI. We are testing the hypotheses that those randomized to the Linkage System 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). In this Administrative Supplement for Research on Bioethical Issues, we will expand the team to include Dr. Appelbaum (ethics and forensic psychiatry expert), Dr. Dixon (mental health services delivery expert), and Dr. Pope (qualitative research expert) as Co-Is for the 1-year Supplement period. We seek supplemental funds to conduct in-depth qualitative interviews with 25 R01 participants for whom the Linkage System was activated (and 18?25 of their close family members) to address three inter-related bioethical concerns. (1) We will conduct an in-depth assessment of the decision-making process during informed consent to better understand patients? views about MH?CJ information sharing. (2) We will assess patients? and family members? views of privacy/confidentiality with regard to the Linkage System and other forms of MH?CJ information sharing. (3) We will explore patients? and family members? benefit/risk perceptions pertaining to the Linkage System intervention, and MH?CJ information sharing more generally. This expanded scope of the R01 will benefit from existing personnel, collaborative relationships, infrastructure, settings, participants, data collection practices, and team capabilities, and our findings will have high policy relevance.
The public health impact of the proposed research is substantial given the national problem of criminalization of persons with serious mental illnesses, which translates into excessive incarceration for what are usually minor charges. Building upon extensive resources, processes, and expertise of an ongoing randomized, controlled trial (R01 MH117191) testing the effectiveness of a potential new form of pre-arrest jail diversion (the Police?Mental Health Linkage System), this Administrative Supplement for Research on Bioethical Issues will collect rich, qualitative data from participating patients (for whom the Linkage System was activated) and their family members. This add-on study will allow us to gain in-depth understandings of three inter-related and highly policy-relevant ethical concerns: (1) patients? decision-making during the informed consent process, and whether their views change after study enrollment and Linkage System activation; (2) patients? (and family members?) views on privacy/confidentiality in the context of information sharing between the mental health and criminal justice sectors; and (3) patients? (and family members?) benefit/risk perceptions pertaining to the Linkage System intervention, and information sharing between mental health and criminal justice sectors more generally.
