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 to be acceptable among 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 an officer 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), as well as 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 patients 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). We are examining 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 risk of arrest. If proven effective, we will prepare a toolkit for other jurisdictions to implement the Linkage System. In this Competing Revision, the research team seeks supplemental funds to conduct in-depth qualitative interviews with 50 enrolling R01 participants (and up to 50 of their close family members) to answer the following questions that must be addressed in order to create new solutions to criminalization: (1) Why do outpatients with SMI have especially high scores on ?criminal sentiments,? which are known to be predictive of CJ recidivism? (2) What are patients? (and family members?) experiences with three specific misdemeanor charges that likely contribute substantially to criminalization? (3) What are patients? (and family members?) preferences among several crisis response models (aside from police-only responses) that might better inform policy and services planning? This expanded scope of the R01 will benefit from existing research personnel, collaborative relationships, infrastructure, settings, participants, data collection practices, and team capabilities.

Public Health 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 supplemental project (Competing Revision) will collect rich, qualitative data from participating patients and their family members. This add-on study will allow us to gain in- depth understandings of: (1) patients? views of the criminal justice system and perceived procedural justice, and how those views relate to high scores on ?criminal sentiments;? (2) patients? (and family members?) experiences with three specific misdemeanor charges that appear to be over-used/over-represented among individuals with serious mental illnesses; and (3) patients? (and family members?) preferences for several crisis response models (aside from police-only intervention) to better inform policy and services planning.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZMH1)
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Juliano-Bult, Denise M
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Columbia University (N.Y.)
Schools of Medicine
New York
United States
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