Improving Mental Health Treatment for Individuals in Crisis Interacting With the Criminal-Legal System

Cambridge Health Alliance1,040 enrolled

Overview

The proposed Center will leverage burgeoning real-time data linkage capabilities among health systems, Medicaid payors, and criminal legal (e.g., jail booking data, jail release data) systems, to identify individuals coming in and out of jail for suicide assessment and prevention, and to better coordinate care across these disparate systems. This Center will advance the fields of suicide prevention and criminal legal system-based mental health by solving a well-known, central problem in both fields: the inability to track and intervene with individuals moving in and out of both and often multiple systems. The goal is near-term reductions in the U.S. suicide rate.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

1,040

Conditions

Suicide Risk Psychiatric Disorders

Interventions

TAU patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the EHR for criminal legal involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved.

FSJSOTHER

Documentation and follow-up by the Cambridge Police Department (CPD) for all mental health-related police calls, including involuntary and voluntary Emergency Department admissions; Established partnerships with city departments, healthcare systems, clergy, courts, businesses, and mental health advocates to ensure timely engagement in mental health treatment and community-based services; Required 40 hours of officer crisis intervention training (CIT), and additional sessions on trauma- informed policing, mental health, race, and crisis negotiation; and Staffing of sworn and civilian staff including specially-trained officers designated to work with individuals living with mental illness, homelessness, and substance abuse.

FSJS+Navigator InterventionOTHER

The FSJS+Navigator intervention adds an Emergency Department (ED)-based Systems Navigator, a community health worker with lived experience (as family member or patient) with criminal legal and mental health systems, to the FSJS. This navigator will enhance communication between Cambridge Police Department (CPD), Cambridge Health Alliance (CHA), and community agencies by being the needed "point person" within the healthcare system (the FSJS intervention only has a CPD-based social worker) to maintain communication to improve mental health services and prevent deeper legal involvement. The Navigator engages with the FSJS process in step i) of the above sequence, engaging the patient in the CHA ED and obtaining consent. The Navigator then discusses the case with the presenting CPD officer, and relays critical information about the context of the service call to ED staff. Next, the Navigator will administer the baseline CAT-MH/SS and assess additional needs (employment, housing, food).

Eligibility

Sex: ALLMin age: 18 YearsMax age: 100 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Treatment as Usual (TAU) arm 1. Cambridge Health Alliance (CHA) patients from the cities other than Cambridge considered to be in the "catchment area" of CHA (Everett, Chelsea, Somerville, Medford, Malden, and Winthrop) 2. Ages 18-100 3. Identified as having police involvement between 2009 and 2025. Treatment as Usual patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the Electronic Health Records for criminal legal involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved. 2. FSJS arm 1. Cambridge Health Alliance patients from Cambridge 2. Ages 18-100 3. Individuals who have come into contact with the Cambridge Police Department (as identified in the FSJS data) between 2009 and 2025. 3. FSJS+Navigator arm 1. Recruited during the study period in the CHA ED 2. Ages 18-100 3. Individuals who are brought into the Emergency Department under police supervision (excluding individuals currently incarcerated) * involuntarily brought to the Emergency Department for psychiatric evaluation because they are considered to be a risk to themselves or others (MA Law 123(12)); or * the subject of a police call for service for a mental health issue who are willingly admitted to the Emergency Department Exclusion Criteria 1. Treatment as Usual (TAU) arm 1. Cambridge Health Alliance patients residing in the City Cambridge are excluded from the TAU arm 2. Under the age of 18 3. Individuals with no identified criminal legal system contact during the study time period (no criminal legal involvement found in the targeted limited chart review method). 4. Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2025). 2. FSJS arm 1. Cambridge Health Alliance patients outside of Cambridge will be excluded from the FSJS arm 2. Under the age of 18 3. Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2025) 3. FSJS+Navigator arm 1. Under the age of 18 2. Any individual who becomes incarcerated during the course of the study 3. Individuals who enter the Emergency Department not under police supervision * For example, individuals will be excluded who voluntarily come to the ED seeking psychiatric care because they feel they may be a risk to themselves or others * Individuals brought to the ED from a jail or court ordered to the ED as an alternative to jail or prison

Outcomes

Primary Outcomes

Past-year medically treated suicide attempt at baseline and 12 months

Number of participants with a past-year medically treated suicide attempt. This will be measured at baseline and 12 months will be collected using the electronic health record (EHR) data.

Time frame: Baseline and 12 months

Suicide Severity and Behaviors using Computerized Adaptive Test Suicide Scale (CAT-SS) at Baseline and 12 Months

The CAT-SS measures Severity of Suicide Risk will be assessed using CAT-SS, providing severity on a 0-100 point scale, and risk-stratification to negligible, intermediate and high risk. It is highly sensitive and specific to the Columbia Suicide Severity Rating Scale, and predicts future suicide events with high precision and accuracy.

Time frame: Baseline and 12 months

Secondary Outcomes

Number of Individual Interactions with the Criminal Legal System at Baseline and 12 Months

Number of calls about each individual to the Cambridge Police Department (CPD) Number of arrests Number of admissions to the Middlesex County Jail Repeat admission to the Middlesex County Jail

Time frame: From enrollment through 12 months

Number of Individual Interactions between Hospitals and the Criminal-Legal System at Baseline and 12 Months

Number of involuntary hospitalizations that require Cambridge Police Department (CPD) interaction

Time frame: From enrollment through 12 months

Frequency of Healthcare Services Used by Patients at Baseline and 12 Months

Number of Emergency Department visits Number of behavioral health inpatient visits Number of behavioral health outpatient mental health (MH) visits

Time frame: From enrollment through 12 months

Improving Mental Health Treatment for Individuals in Crisis Interacting With the Criminal-Legal System

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts