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Myers N, Hutnyan M, Wright G, Lee G, Woodward P, Wilkey J, Young W, Bromley E. Lessons in "Slow" Engagement From Staff and Administrators at a Prebooking Jail Diversion Program. Psychiatr Serv 2022; 73:1117-1122. [PMID: 35414189 DOI: 10.1176/appi.ps.202100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors elicited the perspectives of criminal justice and mental health stakeholders about a prebooking jail diversion program, the Judge Ed Emmett Mental Health Diversion Center, serving primarily individuals experiencing chronic homelessness and diagnosed as having a serious mental illness. METHODS The authors analyzed semistructured interviews with 19 participants and observational fieldnotes from 60 hours of ethnographic fieldwork, conducted from January to July 2020 and including five administrative-level meetings. They used qualitative coding to develop themes. Administrative data were also reviewed. RESULTS Engagement of clients in the program was a major theme. Barriers to engagement included clients’ fear of police involvement and strict rules around smoking. Facilitators to engagement included “slow” engagement, or gradual, gentle microengagements over time and across multiple visits, ideally with peer counselors. CONCLUSIONS To promote client use of services at this critical point of care, jail diversion programs might consider ongoing negotiations with clients to balance expectations between the criminal justice and mental health systems of care by using “slow” client engagement, limiting police involvement, and adopting trauma-informed and harm-reduction approaches.
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Affiliation(s)
- Neely Myers
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Matthew Hutnyan
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Gillian Wright
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Garrett Lee
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Paula Woodward
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Justin Wilkey
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Wayne Young
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
| | - Elizabeth Bromley
- Department of Anthropology, Southern Methodist University, Dallas (Myers, Hutnyan, Wilkey); Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Myers); University of Texas Galveston Medical Branch, Galveston (Wright); Los Angeles County Department of Mental Health, Los Angeles (Lee, Woodward); The Harris Center, Houston (Young); Departments of Anthropology and Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (Bromley); U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles (Bromley)
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Eswaran V, Raven MC, Wang RC, Cawley C, Izenberg JM, Kanzaria HK. Understanding the association between frequent emergency department use and jail incarceration: A cross-sectional analysis. Acad Emerg Med 2022; 29:606-614. [PMID: 35064709 DOI: 10.1111/acem.14437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Frequent emergency department (ED) use and incarceration can be driven by underlying structural factors and social needs. If frequent ED users are at increased risk for incarceration, ED-based interventions could be developed to mitigate this risk. The objective of this study was to determine whether frequent ED use is associated with incarceration. METHODS We conducted a retrospective cross-sectional study of 46,752 individuals in San Francisco Department of Public Health's interagency, integrated Coordinated Care Management System (CCMS) during fiscal year 2018-2019. The primary exposure was frequency of ED visits, and the primary outcome was presence of any county jail incarceration during the study period. We performed descriptive and multivariable analysis to determine the association between the frequency of ED use and jail encounters. RESULTS The percentage of those with at least one episode of incarceration during the study period increased with increasing ED visit frequency. Unadjusted odds of incarceration increased with ED use frequency: odds ratio (OR) = 2.14 (95% confidence interval [CI] = 1.94-2.35) for infrequent use, OR = 4.98 (95% CI = 4.43-5.60) for those with frequent ED use, and OR = 12.33 (95% CI = 9.59-15.86) for those with super-frequent ED use. After adjustment for observable confounders, the odds of incarceration for those with super-frequent ED use remained elevated at 2.57 (95% CI = 1.94-3.41). Of those with super-frequent ED use and at least one jail encounter, 18% were seen in an ED within 30 days after release from jail and 25% were seen in an ED within 30 days prior to arrest. CONCLUSIONS Frequent ED use is independently associated with incarceration. The ED may be a site for intervention to prevent incarceration among frequent ED users by addressing unmet social needs.
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Affiliation(s)
- Vidya Eswaran
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
- National Clinician Scholars Program, Philip R. Lee Institute for Health Policy Studies University of California, San Francisco San Francisco California USA
| | - Maria C. Raven
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
- Philip R. Lee Institute for Health Policy Studies University of California, San Francisco San Francisco California USA
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations University of California, San Francisco San Francisco California USA
| | - Ralph C. Wang
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
| | - Caroline Cawley
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations University of California, San Francisco San Francisco California USA
| | - Jacob M. Izenberg
- Department of Psychiatry and Behavioral Sciences University of California, San Francisco San Francisco California USA
| | - Hemal K. Kanzaria
- Department of Emergency Medicine University of California, San Francisco San Francisco California USA
- Philip R. Lee Institute for Health Policy Studies University of California, San Francisco San Francisco California USA
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations University of California, San Francisco San Francisco California USA
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