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Odes R, Looper P, Manjanatha D, McDaniel M, Goldman ML. Mobile Crisis Teams' Implementation in the Context of new Medicaid Funding Opportunities: Results from a National Survey. Community Ment Health J 2024; 60:1399-1407. [PMID: 38831197 DOI: 10.1007/s10597-024-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/12/2024] [Indexed: 06/05/2024]
Abstract
This cross-sectional survey study describes characteristics of mobile crisis teams (MCTs) in the United States. Mobile crisis teams (MCTs) are increasingly recognized as essential responders to help those experiencing mental health crises get urgent and appropriate care. Recent enhanced federal funding is designed to promote adoption of MCTs, but little is known about their current structure and function and whether teams meet new Medicaid rules governing their utilization. Survey participants (N = 554) are a convenience sample of MCT representatives recruited through professional organizations, listservs, and individual email contacts from October 2021 - May 2022. Respondents most frequently identified themselves as MCT program director/manager (N = 237, 43%). 63% (N = 246) of respondents reported billing insurance for services provided (including Medicaid), while 25% (N = 98) rely on state or county general funds only. Nearly all respondents (N = 390, 98%) reported including behavioral health clinicians on their teams, and 71% (N = 281) reported operating on a 24/7 basis, both of which are required by Medicaid's enhanced reimbursement. Just over half of respondents (N = 191, 52%) reported being staffed with 11 or more FTE staff members, our estimated number required for adequate 2-person coverage on a 24/7 basis. MCTs are a popular policy initiative to reduce reliance on law enforcement to handle mental health emergencies, and enhanced federal funding is likely to expand their utilization. Federal rule makers have a role in establishing guidelines for best practices in staffing, billing, and outcomes tracking, and can help ensure that stable financing is available to improve stability in service delivery.
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Affiliation(s)
- Rachel Odes
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Deepa Manjanatha
- Department of Clinical Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Megan McDaniel
- University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Matthew L Goldman
- Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
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Compton MT, Pope LG, Watson AC. Community-Based Mental Health Crisis Response: An Overview of Models and Workforce Implications. Psychiatr Clin North Am 2024; 47:491-509. [PMID: 39122342 DOI: 10.1016/j.psc.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Communities across the United States are working to improve community-based mental health crisis response, with 1 goal being to reduce criminal legal system involvement among individuals with mental illnesses, behavioral disorders, or mental health crises. Existing and recently developed models can generally be divided into non-law enforcement-based response models and law enforcement-based response models. Wide variation exists in terms of staffing, how response teams are called out or dispatched, hours of operation and immediacy of response, and approaches to crisis resolution.
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Affiliation(s)
- Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | - Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Amy C Watson
- School of Social Work, Wayne State University, Deroit, MI, USA
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3
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Cheetham A, Babcock L, Hartwell V, Schwartz H, Bensman R, Lee SH, Riney L, Semenova O, Zhang Y, Pomerantz WJ. Emergency Department Pediatric Mental and Behavioral Health Patients Transported by Emergency Medical Services and Police: Trends and Interventions. Acad Pediatr 2024; 24:1001-1009. [PMID: 38754700 DOI: 10.1016/j.acap.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE We aimed to understand transport utilization trends, demographics, emergency department (ED) interventions, and outcomes of pediatric mental and behavioral health (MBH) patients transported by emergency medical services (EMS), police, or self-transported. METHODS This retrospective cohort study utilized electronic health record data from patients aged 5 to 18 years presenting with acute MBH conditions at 2 affiliated pediatric EDs from January 2012 to December 2020. Data included demographics, ED interventions for aggression/agitation, Brief Rating of Aggression by Children and Adolescents (BRACHA) scores, and ED dispositions. Descriptive statistics and comparative analyses were conducted using chi-square, Wilcoxon rank sum tests, and multivariable logistic regression. Linear regression analyzed trends. RESULTS Of 440,302 ED encounters, 70,557 (16%) were for acute MBH concerns, with 14.6% transported by EMS and 5.9% by police. The proportion of MBH visits increased from 9.9% in 2012 to 19.8% in 2020 (95% (confidence interval) CI [0.7, 1.7], P = 0.0009), with a concurrent 0.4% annual increase in those transported by EMS (95% CI [0.2, 0.6], P = 0.006). MBH patients transported by EMS and police had significantly higher odds of requiring restraint in the ED and were more likely to have higher BRACHA scores and to be admitted compared to self-transported patients (all comparisons, P < 0.001). CONCLUSIONS Pediatric MBH ED visits and EMS utilization are increasing. MBH patients transported by EMS and police may represent a more aggressive ED population. Given the rising encounters within this high-risk population, our EDs, EMS, and police need support and resources for safe pediatric MBH patient management.
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Affiliation(s)
- Alexandra Cheetham
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio.
| | - Lynn Babcock
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Victoria Hartwell
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Hamilton Schwartz
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Rachel Bensman
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Sang Hoon Lee
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Lauren Riney
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
| | - Olga Semenova
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | - Yin Zhang
- Division of Biostatistics and Epidemiology (Y Zhang), Cincinnati Children's Hospital Medical Center, Ohio
| | - Wendy J Pomerantz
- Division of Pediatric Emergency Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, O Semenova, and WJ Pomerantz), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (A Cheetham, L Babcock, V Hartwell, H Schwartz, R Bensman, SH Lee, L Riney, and WJ Pomerantz), Ohio
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Zitars J, Scharf D. Matching Mobile Crisis Models to Communities: An Example from Northwestern Ontario. J Behav Health Serv Res 2024; 51:355-376. [PMID: 38691301 PMCID: PMC11180628 DOI: 10.1007/s11414-024-09882-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 05/03/2024]
Abstract
Police are often the first to encounter individuals when they are experiencing a mental health crisis. Other professionals with different skill sets, however, may be needed to optimize crisis response. Increasingly, police and mental health agencies are creating co-responder teams (CRTs) in which police and mental health professionals co-respond to crisis calls. While past evaluations of CRTs have shown promising results (e.g. hospital diversions; cost-effectiveness), most studies occurred in larger urban contexts. How CRTs function in smaller jurisdictions, with fewer complementary resources and other unique contextual features, is unknown. This paper describes the evaluation of a CRT operating in a geographically isolated and northern mid-sized city in Ontario, Canada. Data from program documents, interviews with frontline and leadership staff, and ride-along site visits were analyzed according to an extended Donabedian framework. Through thematic analysis, 12 themes and 11 subthemes emerged. Overall, data showed that the program was generally operating and supporting the community as intended through crisis de-escalation and improved quality of care, but it illuminated potential areas for improvement, including complementary community-based services. Data suggested specific structures and processes of the embedded CRT model for optimal function in a northern context, and it demonstrated the transferability of the CRT model beyond large urban centres. This research has implications for how communities can make informed choices about what crisis models are best for them based on their resources and context, thus potentially improving crisis response and alleviating strain on emergency departments and systems.
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Affiliation(s)
- Jillian Zitars
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
| | - Deborah Scharf
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada.
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Oppenheim S, Webb L, Testa A, Fix RL, Clary L, Mendelson T, Jackson DB. Police Violence Exposure and Traumatic Stress Among Youth: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241255735. [PMID: 38903028 DOI: 10.1177/15248380241255735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Youth exposure to violence increases the risk of poor mental and physical health outcomes lasting into adulthood. Traumatic stress is an outcome of particular concern as the physiological stress response impacts the developing brain. Recently, youth exposure to police violence has been conceptualized as an adverse childhood experience that may impact traumatic stress. To examine this possibility, we conducted a systematic review, drawing upon five databases to gather the existing quantitative and qualitative peer-reviewed research on exposure to police violence and traumatic stress in youth. Searches yielded 27 relevant articles utilizing various study designs: thirteen quantitative, thirteen qualitative, and one mixed method. Twenty-six of the 27 studies found evidence of a relationship between police violence exposure and traumatic stress in youth. Police violence was associated with youth traumatic stress across three types of exposures: direct, vicarious, and anticipated. Studies also explored differential impacts by race and gender. The review revealed current gaps in the literature, such as a lack of data on select sociodemographic groups (e.g., rural youth, LGBTQ+ youth) and potential protective factors (e.g., resilience and school connectedness). In line with the findings, we put forth a research agenda as well as policy and practice recommendations to improve police interactions with youth and mental health services for youth who have been exposed to police violence. Recommendations include improving systematic data collection to track all types of police violence exposure, creating spaces for positive police interactions with youth, and training mental health practitioners to support youth exposed to police violence.
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Affiliation(s)
| | - Lindsey Webb
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- The University of Texas Health Science Center at Houston, USA
| | - Rebecca L Fix
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laura Clary
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dylan B Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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6
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Causier C, Waite F, Sivarajah N, Knight MTD. Structural barriers to help-seeking in first-episode psychosis: A systematic review and thematic synthesis. Early Interv Psychiatry 2024; 18:293-311. [PMID: 38356356 DOI: 10.1111/eip.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/18/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024]
Abstract
AIM Access to timely treatment is key to early intervention in psychosis. Despite this, barriers to treatment exist. In this review, we aimed to understand the structural barriers that patients and caregivers face in help-seeking for first-episode psychosis, and the recommendations provided to address these. METHODS We conducted a systematic review (PROSPERO: CRD42021274609) of qualitative studies reporting structural barriers to help-seeking from the patient or caregiver perspective. Searches were performed in September 2023, restricted to studies published from 2001. Study quality was appraised using Critical Appraisal Skills Programme. Data were analysed using thematic synthesis. RESULTS Nineteen papers from 11 countries were included. Across all papers, participants reported experiencing structural barriers to receiving healthcare. For many patients and caregivers, the process of accessing healthcare is complex. Access requires knowledge and resources from parents, caregivers and healthcare providers, yet too often there is a misalignment between patients' needs and service resources. Expertise amongst healthcare providers vary and some patients and caregivers experience negative encounters in healthcare. Patients highlighted earlier caregiver involvement and greater peer support as potential routes for improvement. CONCLUSION Patients and caregivers face multiple structural barriers, with legislative practices that discourage family involvement, and healthcare and transport costs found to be particularly problematic. Understanding these barriers can facilitate the co-design of both new and existing services to provide easier access for patients and caregivers. Further research is needed focusing not only on the perspectives of patients and caregivers who have accessed professional help but also crucially on those who have not.
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Affiliation(s)
- Chiara Causier
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Felicity Waite
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Nithura Sivarajah
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Matthew T D Knight
- Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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7
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Anestis JC, Halkitis PN, Cordeiro A, Lanman MJ, Passannante MR. ARRIVE Together: A Qualitative Process Evaluation of the New Jersey State Police Co-responding Pilot Program. Behav Med 2024:1-10. [PMID: 38449435 DOI: 10.1080/08964289.2024.2324793] [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] [Received: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
Law enforcement personnel are often first to respond to calls involving behavioral health emergencies. However, encounters with law enforcement are more dangerous and lethal for people with behavioral health conditions. Co-responding models, wherein law enforcement and behavioral health professionals respond to calls together, are among the top programs developed to improve responding to behavioral health crises. The current study describes a qualitative process evaluation of a co-responding pilot program in New Jersey: "Alternative Responses to Reduce Instances of Violence & Escalation" (ARRIVE Together). The evaluation centered on the experience of the co-responding team as to their perceptions of specific deployments and of the program implementation overall. Semi-structured interviews were conducted following 10 consecutive encounters (three interviews per encounter; February-March 2022). Transcripts were transcribed and thematically analyzed by two trained researchers independently. Once thematically analyzed, researchers determined a consensus and developed a SWOT analysis report. Thematic analysis produced six major themes: communication, staffing, training, resources, community outreach, and deployments with minors. Overall, participants were enthusiastic about the program, but they shared numerous observations about ways in which the program could be improved. Sample size, the brief follow-up window, and lack of generalizability to other contexts were among the most limiting factors. Further research should include an effectiveness evaluation and extend to urban and suburban communities and communities of color. Future research should also explore after-response affects including accessibility to follow-up care. The current study gives insight into piloting a co-responding model for approaching behavioral health crisis calls.
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Affiliation(s)
- Joye C Anestis
- Department of Health Behavior, Society, & Policy, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Perry N Halkitis
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Alana Cordeiro
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, USA
| | - Melissa J Lanman
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, USA
| | - Marian R Passannante
- Department of Biostatistics and Epidemiology, School of Public Health, Rutgers, The State University of New Jersey, New Brunswick, USA
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Lowder EM, Grommon E, Bailey K, Ray B. Police-mental health co-response versus police-as-usual response to behavioral health emergencies: A pragmatic randomized effectiveness trial. Soc Sci Med 2024; 345:116723. [PMID: 38422686 DOI: 10.1016/j.socscimed.2024.116723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/27/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND People with mental illness are overrepresented in United States (US) criminal legal systems. In response, alternatives to traditional police response to behavioral health emergencies have become more common, despite limited evidence for their effectiveness. We conducted the first randomized controlled trial of a police-mental health co-response team to determine program effectiveness relative to a police-as-usual response on key outcomes identified by community stakeholders. METHODS Between January 2020 and March 2021, we randomized behavioral health emergency calls for service in one of six police districts in Indianapolis, Indiana to receive a co-response or police-as-usual response during operational hours between 10 a.m. and 5 p.m. Mondays - Fridays. Eligible calls for service were determined via pre-specified phrases indicating a behavioral health incident over the police dispatch radio. Researchers then communicated random assignment with the co-response team to indicate whether they should respond or withhold. Logistic and negative binomial regression were used to assess group differences in emergency medical services (EMS) events within 12 months of the randomized incident along with jail booking, outpatient encounters, and emergency department visits. FINDINGS We randomized 686 calls for service with co-response completed in 264 cases and police-as-usual response in 267 cases. The overall rate of attrition was similar across conditions and the final sample included 211 co-responses and 224 police-as-usual responses. We found no significant differences in any EMS event (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 0.85-1.88, p = .246) or event counts (incidence rate ratio [IRR]: 0.85; 95% CI: 0.52-1.37, p = .504). We also found no differences in secondary outcomes (jail booking, outpatient encounters, and emergency department visits). DISCUSSION A police-mental health co-response team model was not more effective than traditional police response on key outcomes. Co-response team models, such as the one reported here, may unintentionally foster emergency services utilization among persons with behavioral health needs. Without a functioning national mental health system, communities in the US will continue to struggle to identify solutions to meet the needs of community members with complex behavioral health issues.
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Affiliation(s)
- Evan Marie Lowder
- George Mason University Department of Criminology, Law and Society, 4400 University Drive, 4F4, Fairfax, VA, 22030, United States
| | - Eric Grommon
- Indiana University O'Neill School of Public and Environmental Affairs, 801 W. Michigan Street BS 3025, Indianapolis, IN, 46202, United States
| | - Katie Bailey
- University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, United States
| | - Bradley Ray
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, United States.
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Compton MT, Frimpong EY, Ehntholt A, Zhu H, Chaudhry S, Ferdousi W, Rowan GA, Radigan M, Smith TE, Rotter M. Associations between Social Adversities and Chronic Medical Conditions in a Statewide Sample of Individuals in Treatment for Mental Illnesses. Community Ment Health J 2024; 60:251-258. [PMID: 37395820 DOI: 10.1007/s10597-023-01165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Individuals with mental illnesses experience disproportionately high rates of social adversities, chronic medical conditions, and early mortality. We analyzed a large, statewide dataset to explore associations between four social adversities and the presence of one or more, and then two or more, chronic medical conditions among individuals in treatment for mental illnesses in New York State. In Poisson regression models adjusting for multiple covariates (e.g., gender, age, smoking status, alcohol use), the presence of one or more adversities was associated with the presence of at least one medical condition (prevalence ratio (PR) = 1.21) or two or more medical conditions (PR = 1.46), and two or more adversities was associated with at least one medical condition (PR = 1.25) or two or more medical conditions (PR = 1.52) (all significant at p < .0001). Greater attention to primary, secondary, and tertiary prevention of chronic medical conditions is needed in mental health treatment settings, especially among those experiencing social adversities.
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Affiliation(s)
- Michael T Compton
- New York State Psychiatric Institute, New York, NY, USA.
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | | | - Amy Ehntholt
- New York State Psychiatric Institute, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Huilin Zhu
- New York State Office of Mental Health, Albany, NY, USA
| | | | | | - Grace A Rowan
- New York State Office of Mental Health, Albany, NY, USA
| | | | - Thomas E Smith
- New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Merrill Rotter
- New York State Office of Mental Health, Albany, NY, USA
- Albert Einstein College of Medicine, New York, NY, USA
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10
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Petreca VG, Barros JT, Hoblock C, Burgess AW. The Nurse-Police Assistance Crisis Team (N-PACT): A new role for nursing. J Adv Nurs 2024. [PMID: 38225816 DOI: 10.1111/jan.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/09/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
AIM This study aimed to gain insights into forensic nurses' perspectives and approaches to behavioural crisis situations, comparing them to disciplines traditionally involved in first-line behavioural crisis response. DESIGN This study used a descriptive, qualitative exploratory design and was informed by Systems Theory. METHODS The study was carried in the United States, between 2022 and 2023. Data were gathered through four focus groups: police officers (n = 12), co-response (mental health) clinicians (n = 13), sexual assault nurse examiners (n = 6) and correctional nurses (n = 4). Thematic analysis was performed. REPORTING METHOD The Standards for Reporting Qualitative Research (SRQR) guidelines were used. RESULTS Findings revealed temporal themes in crisis response: (1) Searching for Historical Information; (2) Safety and Acting at the Present Scene; and (3) Future Strategies and Interventions. Common priorities (e.g. safety and de-escalation) were identified across groups. Notably, nurses demonstrated a comprehensive approach, addressing physical and mental health assessments, substance involvement, and physical injury evaluation. CONCLUSION This study proposes the creation of a novel nursing role within first-line multidisciplinary teams (MDTs) for crisis response-the Nurse-Police Assistance Crisis Team (N-PACT). Nurses bring expertise and comprehensive assessment skills to enhance crisis responses, particularly in cases involving mental health emergencies, medical crises, and drug-related incidents. IMPLICATIONS Forensic nurses, with their diverse competencies and comprehensive training, are highly valuable assets within MDTs. Their expertise extends to proficiently conducting mental and physical assessments, ensuring safety and adeptly navigating situations that intersect with the legal system. IMPACT The N-PACT concept can improve outcomes and streamline the allocation of resources, particularly considering the number of police calls involving behavioural crises. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Dahlem CH, Patil R, Khadr L, Ploutz-Snyder RJ, Boyd CJ, Shuman CJ. Effectiveness of take ACTION online naloxone training for law enforcement officers. HEALTH & JUSTICE 2023; 11:47. [PMID: 37979100 PMCID: PMC10656891 DOI: 10.1186/s40352-023-00250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Training law enforcement officers (LEOs) to administer naloxone is a recommended strategy to reduce overdose deaths in the United States. To achieve this, an evidence-based and scalable naloxone training curriculum that is easy to use and readily scalable is needed. Convenient web-based training is a flexible method for delivering educational interventions particularly for LEOs who have irregular or shifting schedules. This study examined the effectiveness of a comprehensive web-based naloxone training that was created in partnership with LEOs on their knowledge, confidence, and attitudes regarding naloxone. METHODS From May 2019 to September 2020, five law enforcement departments from Michigan participated in web-based naloxone training. A total of 182 LEOs (77% male) were in the final sample based on matching pre-and post-test surveys. LEOs were assessed on knowledge, confidence, and attitudes towards naloxone. Negative binomial and Poisson regression was conducted to assess associations between knowledge, confidence, and attitudes towards naloxone before and after training. RESULTS Significant improvements in overdose knowledge and confidence were revealed across all departments with median (IQR) total composite scores for knowledge increasing from 35 (32, 37) to 40 (39, 42) (p < 0.01) and confidence increasing from 18.5 (15, 20) to 20 (20, 25) (p < 0.01). Median (IQR) attitude scores did not change. CONCLUSION Our web-based naloxone training was effective in improving knowledge and confidence for LEOs but did not significantly improve LEOs attitudes towards naloxone across most departments. The web-based format is readily scalable and quickly disseminated and meets the immediate need for LEO overdose training. Additional intervention is needed to address the negative attitudes of LEOs regarding naloxone.
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Affiliation(s)
- Chin Hwa Dahlem
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA.
| | - Rohan Patil
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Lara Khadr
- Applied Biostatistics Laboratory, Ann Arbor, USA
| | | | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
| | - Clayton J Shuman
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 N. Ingalls Rd Rm 3174, Ann Arbor, MI, 48109, USA
- Department of System Populations and Leadership, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
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12
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Pope LG, Patel A, Fu E, Zingman M, Warnock A, Ellis S, Ashekun O, Watson A, Wood J, Compton MT. Crisis Response Model Preferences of Mental Health Care Clients With Prior Misdemeanor Arrests and of Their Family and Friends. Psychiatr Serv 2023; 74:1163-1170. [PMID: 37070262 PMCID: PMC11408879 DOI: 10.1176/appi.ps.20220363] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The overrepresentation of people with serious mental illnesses in the criminal legal system has spurred the development of crisis response models to improve or reduce police response to a mental health crisis. However, limited research has explored preferences for crisis response, and no research in the United States has examined the responses desired by mental health care clients or their family members. This study aimed to understand the experiences of people with serious mental illnesses interacting with police and to learn about their preferences for crisis response models. The authors interviewed 50 clients with serious mental illnesses and a history of arrest who were enrolled in a randomized controlled trial of a police-mental health linkage system, as well as 18 of their family members and friends. Data were coded with deductive and inductive approaches and were grouped into larger themes. Clients and family or friends described needing a calm environment and empathy during a crisis. They selected a nonpolice response as their first choice and response from a crisis intervention team as their last choice among four options, highlighting the importance of trained responders and past negative interactions with police. However, they also noted concerns about safety and the shortcomings of a nonpolice response. These findings build understanding about clients' and family members' preferences for crisis response and highlight concerns that are relevant for policy makers.
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Affiliation(s)
- Leah G Pope
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Ashnee Patel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - En Fu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael Zingman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amanda Warnock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Samantha Ellis
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Oluwaytoyin Ashekun
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Amy Watson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Jennifer Wood
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons (Pope, Patel, Fu, Warnock, Compton), and New York State Psychiatric Institute (Pope, Compton), New York City; New York University Langone Medical Center, New York City (Zingman); Gateway Behavioral Health Services, Savannah, Georgia (Ellis); DeKalb Community Service Board, Atlanta (Ashekun); Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, Milwaukee (Watson); Department of Criminal Justice, Temple University, Philadelphia (Wood)
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13
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Price JH, Khubchandani J. Lethal Force Usage by Law Enforcement Officers Against Hispanics, 2011-2020. J Community Health 2023; 48:819-823. [PMID: 37131067 DOI: 10.1007/s10900-023-01222-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
Most research on lethal force by law enforcement officers (LEOs) has focused on firearm deaths by LEOs among certain racial groups (e.g., African Americans). Specifically, not much is known about LEOs-induced lethal injuries among Hispanics. The purpose of this study was to characterize LEOs induced fatal injuries, the methods used, among various demographic groups of Hispanics, and the years of potential life lost before the age of 80 years due to lethal force by LEOs. Data from the Web-Based Injury Statistics Query and Reporting System (WISQARS) were analyzed for the years 2011-2020. LEOs killed 1,158 Hispanics; most were males (96.2%) with the majority being shot (89.9%). Two-thirds (66.9%) of those killed were Hispanics 20-39 years of age and from the Western U.S. These Hispanic deaths resulted in 53,320 YPLLs. Males and those ages 20-39 years lost the most YPLLs. The rate of fatal encounters with LEOs for Hispanics grew by 44.4% over the decade, with the highest rate in 2020. Mitigation of unnecessary Hispanic deaths by LEOs needs to include changes in law enforcement agency policies, hiring practices for LEOs, improved data collection for LEOs use of lethal force, improved mental healthcare and training for LEOs, use of less lethal strategies for citizen control by law enforcement, deference education for all young adults, and long-term changes in social forces that have created and maintained disenfranchised communities of color.
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Affiliation(s)
- James H Price
- Emeritus Professor of Public Health, University of Toledo, 43606, Toledo, OH, United States.
| | - Jagdish Khubchandani
- Professor of Public Health, New Mexico State University, 88003, Las Cruces, NM, United States
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14
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Shefner RT, Koppel R, Wood J, Anderson ED. Co-Deployment is an Answer, but What are the Questions? Insights from Officer Focus Groups in Philadelphia. POLICE PRACTICE & RESEARCH : AN INTERNATIONAL JOURNAL 2023; 24:728-734. [PMID: 37981953 PMCID: PMC10655952 DOI: 10.1080/15614263.2023.2180360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/09/2023] [Indexed: 11/21/2023]
Abstract
Cities have been experimenting with less police-centered models for responding to people experiencing mental health crises. Ten focus groups were conducted with Philadelphia police officers to understand their experiences encountering mental health distress in the community and their perspectives on a new co-deployment initiative. There was general consensus that conventional police-centered responses to mental health concerns are often problematic. However, perspectives varied on the value of co-deployment and the general feasibility of reducing police involvement. This variation is traced to different notions of what constitutes a mental health crisis, whether crises are prospectively identifiable, how dangerousness is assessed, and whether civilian co-response partners will effectively complete key response activities. Bringing greater understanding and consensus to these issues is essential to healthier and more effective responses to mental health crises.
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Affiliation(s)
- Ruth T. Shefner
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 W 168 Street, New York, NY
| | | | | | - Evan D. Anderson
- University of Pennsylvania, School of Medicine, 3620 Hamilton Walk, Philadelphia, Pennsylvania 19104, United States
- University of Pennsylvania, School of Nursing, 418 Curie Boulevard, Philadelphia, Pennsylvania 19104, United States
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15
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Ward JA, McGinty EE, Hudson T, Stone EM, Barry CL, Webster DW, Crifasi CK. Reimagining public safety: Public opinion on police reform and gun violence prevention by race and gun ownership in the United States. Prev Med 2022; 165:107180. [PMID: 35933003 PMCID: PMC9722519 DOI: 10.1016/j.ypmed.2022.107180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 07/30/2022] [Indexed: 11/27/2022]
Abstract
Inequitable experiences of community gun violence and victimization by police use of force led to nationwide calls to "reimagine public safety" in 2020. In January 2021, we examined public support among U.S. adults for 7 policy approaches to reforming policing and investing in community gun violence prevention. Using a nationally representative sample (N = 2778), with oversampling for Black Americans, Hispanic Americans, and gun owners, we assessed support overall and by racial, ethnic, and gun owner subgroups. Overall, we found majority support for funding and implementing police and mental health co-responder models (66% and 76%, respectively), diversion from incarceration for people with symptoms of mental illness (72%), stronger laws to assure police accountability (72%), and funding for community-based and hospital-based gun violence prevention programs (69% and 60%, respectively). Support for redirecting funding from the police to social services was more variable (44% overall; White: 35%, Black: 60%, Hispanic: 43%). For all survey items, support was strongest among Black Americans. Gun owners overall reported lower support for public safety reforms and investments than respondents who did not own guns, but this distinction was found to be driven by White gun owners. The views of Black gun owners were indistinguishable from Black non-owners and were similar to White non-owners on most issues. These findings suggest that broad public support exists for innovative violence reduction strategies and public safety reforms.
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Affiliation(s)
- Julie A Ward
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Talib Hudson
- Department of Public and Urban Policy, The New School Milano School of Policy, Management, and Environment, New York, NY, USA
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colleen L Barry
- Cornell Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
| | - Daniel W Webster
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Cassandra K Crifasi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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16
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Marshall P, Jones S, Gooding P, Robinson H, Lobban F. Caring for a Family Member with Psychosis or Bipolar Disorder Who Has Experienced Suicidal Behaviour: An Exploratory Qualitative Study of an Online Peer-Support Forum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15192. [PMID: 36429907 PMCID: PMC9690796 DOI: 10.3390/ijerph192215192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/10/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The likelihood of suicidal behaviour is elevated amongst people with psychosis or bipolar disorder. This study aimed to understand how carers experience supporting family members with psychosis or bipolar disorder who have also experienced suicidal behaviour. METHODS A qualitative thematic analysis of online peer forum posts was carried out on the Relatives Education and Coping Toolkit (REACT) website, an online intervention for carers of people with psychosis and bipolar disorder. Analysis was based on 178 posts by 29 forum users. Posts were selected based on their relevance to suicidal behaviour. RESULTS Three themes were generated. "Suicide as the ultimate threat" highlights fears emerging from carers' difficulties with understanding and managing suicidal behaviour. "Bouncing from one crisis to another" reflects carers' experiences of recurring crises and the challenges of relying on emergency healthcare support. "It definitely needs to be easier to get help" emphasises carers' desires to be acknowledged by healthcare professionals and included in support offered to service users. CONCLUSIONS Digital platforms, including online forums, brief interventions such as safety planning, and interagency crisis models, hold the potential to meet carers' needs in this context. However, further research is required to investigate the effectiveness and implementation of these approaches.
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Affiliation(s)
- Paul Marshall
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Steven Jones
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Heather Robinson
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
| | - Fiona Lobban
- Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK
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