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

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

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.

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