There is increased concern that individuals with mental illness are involved with the criminal justice system too frequently and that these encounters may lead to the exacerbation of mental health symptoms, including suicide attempts. Understanding the intersection between mental health treatment, Emergency Department (ED) use, and criminal justice involvement is crucial to supporting individuals with mental illness. Criminal justice liaison and diversion services can provide an opportunity to identify individuals with mental disorders and connect them to appropriate services, but multi-system interventions are hampered by a lack of training of law enforcement, poor communication, different priorities between healthcare providers and law enforcement, and well-known and persistent silos between criminal justice, emergency services, and inpatient and outpatient psychiatric services.
In response, the Cambridge Police Department (CPD), Massachusetts, has developed the Family and Social Justice Section (FSJS) intervention, a police-based multi-system intervention to train patrol officers in mental health first aid and trauma-informed policing, link community and healthcare services, and follow-up on mental health-related calls with police department-based case management using a team of specialty mental health resource officers and mental health clinicians. The FSJS is a team-based, multidisciplinary approach delivered at Intercepts 0 and 1 of the Sequential Intercept Model (community services and contact with law enforcement) intended to reduce arrest, court involvement, ED visits and calls for service by police for individuals in mental health (including suicide) crisis.
While preliminary qualitative evaluation of the FSJS intervention demonstrated some success in pre-adjudication diversion, it also identified a disconnect in information-sharing across systems.
Project 4 will compare three study conditions among justice-involved individuals in mental health crises transported to the ED (voluntarily or involuntarily) by the police. Most such individuals present with suicide-related concerns.
The three conditions include:
- The FSJS+Navigator arm includes eligible individuals (n=40) transported to ED by CPD and recruited in the ED. This intervention will employ a system navigator to coordinate and build relationships among CPD and two Cambridge EDs, to update the team with data-driven feedback (to the extent allowed by law) on each patient’s clinical, legal, and community situation to ensure coordination of care, and to provide outreach and assistance to each patient in accessing follow-up clinical and community services. The Navigator solves the identified problem by assigning a lead case manager/patient advocate who communicates across healthcare and legal systems and coordinates information-sharing.
- The FSJS arm includes eligible individuals identified in chart reviews as having FSJS contact resulting from the same two Cambridge EDs visiting for substantial risk to self or others (n=200) during the study period. Individuals in this condition will be: (a) brought in by CPD (vs. control cities), and (b) not enrolled in FSJS+Navigator (i.e., presenting when research staff is unavailable).
- The treatment as usual (TAU) arm patients will include 800 eligible individuals bought to the same EDs from control cities (Everett, Chelsea, Somerville, Medford, Malden) that are similar in size and demographics to Cambridge. TAU patients will be identified using targeted, limited chart review methods used in our prior studies, “scraping” clinical notes in the EHR for criminal justice involvement and ED use.
The research team will use a data warehouse that merges data from CPD, Corrections, ED electronic health records, claims, and area-level socio-contextual data to guide Navigator follow-up and outreach and to evaluate intervention outcomes. All three samples will be collected prospectively and analyzed using a propensity score-weighted difference-in- difference design. Outcomes include medically treated suicide attempts (primary), mental health and service use outcomes, and arrests (secondary).