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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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Kafka JM, Adhia A, Martin DD, Mustafa A, Rowhani-Rahbar A, Rivara FP. Deaths Related to Domestic Violence in Washington State. JAMA Netw Open 2024; 7:e2429974. [PMID: 39230906 PMCID: PMC11375474 DOI: 10.1001/jamanetworkopen.2024.29974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/30/2024] [Indexed: 09/05/2024] Open
Abstract
Importance Domestic violence (DV; including intimate partner and family violence) is associated with heightened lethality risks, yet limited research has comprehensively assessed the connection between DV and fatal violence considering both homicides and suicides. Understanding the fatal consequences of DV can point to missed opportunities to support individuals and their families. Objective To assess the proportion of violent deaths that were connected to DV and describe contacts with the legal system or social services prior to each DV-related fatality. Design, Setting, and Participants This cross-sectional study used quantitative and qualitative data from the National Violent Death Reporting System (NVDRS) for all individuals who died by homicide or suicide in Washington from January 1, 2015, to December 31, 2020. Analyses were conducted from August 1, 2022, to September 30, 2023. Main Outcomes and Measures A multipronged approach was used to assess DV history using existing NVDRS variables, leveraging data from prior review of NVDRS death narratives, applying a validated natural language processing tool, and linking related deaths. Domestic violence was recorded as yes or no, but the decedent's role in the abusive relationship (ie, experiencing or enacting DV) could not be differentiated. To describe system involvement prior to each death, keyword searching and hand review of NVDRS death narratives were used. Results A total of 7352 intentional violent deaths (1192 homicides [16.2%]; 6160 suicides [83.8%]) with known circumstances were recorded in Washington during the study period. Of these, 948 deaths (12.9%) were connected to DV (624 [65.8%] among males; mean [SD] age at death, 45.3 [19.2] years), including 588 suicides (62.0%) and 360 homicides (38.0%). For 420 DV-related deaths (44.3%), there was evidence to suggest that the person who died or their intimate partner(s), family, or cohabitants had prior contacts with the legal system or social services. Specifically, 318 records (33.5%) mentioned prior contacts with law enforcement or the criminal legal system (eg, prior 9-1-1 calls, criminal convictions), and 225 (23.7%) described engagement with social services or the civil legal system (eg, civil protection order, divorce, or child custody problems). Conclusions and Relevance In this cross-sectional study, 12.9% of violent deaths in Washington were connected to DV. The findings suggest that more resources are needed to support law enforcement, court professionals, and social services specialists to proactively identify and refer families to wraparound supports before the situation can escalate to a fatality.
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Affiliation(s)
- Julie M. Kafka
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Avanti Adhia
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- School of Nursing, University of Washington, Seattle
| | - David D. Martin
- King County Prosecuting Attorney’s Office, Seattle, Washington
| | - Ayah Mustafa
- Firearm Injury & Policy Research Program, University of Washington, Seattle
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Frederick P. Rivara
- Firearm Injury & Policy Research Program, University of Washington, Seattle
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
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Udo T, Roberts PC, Dyett J, Mullin S, Cummings D, Morano C. Opportunities and Challenges to Build Behavioral Health Crisis Capacity in Rural America. Psychiatr Serv 2024; 75:826-829. [PMID: 38650491 DOI: 10.1176/appi.ps.20230111] [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: 04/25/2024]
Abstract
This column shares lessons learned from a 1-year pilot implementation of a crisis response program deploying crisis professionals to rural parts of Albany County, New York. The data (325 crisis interventions for 191 unique individuals, 57% of cases resolved on the scene) suggest that the program helps fill the crisis services gap in these communities. Police were present on 80% of cases. Educating police to build confidence in the program and providing clearer guidelines on the triage process for dispatchers may be important strategies to continue shifting crisis response duties from traditional first responders to crisis professionals.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Preston Cody Roberts
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Jordan Dyett
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Shannon Mullin
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Denard Cummings
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Carmen Morano
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
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Gonzalez Miranda LA, Shetty A, Ehlke D. Analyzing Alternative Behavioral Crisis Response Models in the U.S. J Community Health 2024; 49:324-329. [PMID: 37940735 DOI: 10.1007/s10900-023-01299-1] [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: 10/16/2023] [Indexed: 11/10/2023]
Abstract
In the U.S., communities often rely on the criminal justice system to respond to, house, and treat individuals with mental health and substance use problems. This has resulted in a crisis response system that relies on police officers to respond to mental and behavioral health crisis due to a lack of options. Unfortunately, these encounters can be dangerous for individuals in need of help. Additionally, this has led to a disproportionate number of individuals with mental illness and substance use disorders being housed in prisons. Alternatives to our current crisis response system already exist in the form of community-based mobile crisis response teams that rely on mental health workers instead of law enforcement. This review examines such programs that have been enacted in multiple cities across the country. Analysis of these alternative crisis response models shows that community-based programs are more effective, efficient, and safer than the current standard that relies on law enforcement. This analysis highlights the need for the establishment of community-based crisis response teams as the national standard.
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Affiliation(s)
- Luis A Gonzalez Miranda
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA.
| | - Anuradha Shetty
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Daniel Ehlke
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
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Carroll JJ, Cummins ER, Formica SW, Green TC, Bagley SM, Beletsky L, Rosenbloom D, Xuan Z, Walley AY. The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104160. [PMID: 37597344 DOI: 10.1016/j.drugpo.2023.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. METHODS We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. RESULTS Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). CONCLUSIONS Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States; Department of Medicine, Brown University, 222 Richmond St., Providence, RI 02903, United States.
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Health in Justice Action Lab, Northeastern University, 416 Huntington Ave, Boston, MA 02115, United States
| | - David Rosenbloom
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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Murray CH, Contreras JL, Kelly CH, Padgett DK, Pollack HA. Behavioral Crisis and First Response: Qualitative Interviews with Chicago Stakeholders. Community Ment Health J 2023; 59:77-84. [PMID: 35751789 PMCID: PMC9243918 DOI: 10.1007/s10597-022-00990-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/18/2022] [Indexed: 01/07/2023]
Abstract
Improving interactions between first responders and individuals experiencing behavioral crisis is a critical public health challenge. To gain insight into these interactions, key informant qualitative interviews were conducted with 25 Chicago stakeholders. Stakeholders included directors and staff of community organizations and shelters that frequently engage first responders. Interviews included granular depictions related to the expectations and outcomes of 911 behavioral crisis calls, and noted areas requiring improved response. Stakeholders called 911 an average of 2 to 3 times per month, most often for assistance related to involuntary hospitalization. Engagements with first responders included unnecessary escalation or coercive tactics, or conversely, refusal of service. While stakeholders lauded the value of police trained through the city's Crisis Intervention Team program, they emphasized the need for additional response strategies that reduce the role of armed police, and underscored the need for broader social and behavioral health services for individuals at-risk of such crises.
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Affiliation(s)
- Conor H. Murray
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
- Urban Health Lab, University of Chicago, Chicago, USA
| | - Juan L. Contreras
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
| | - Caroline H. Kelly
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
| | - Deborah K. Padgett
- Silver School of Social Work, New York University, 1 Washington Square N, New York, NY 10003 USA
| | - Harold A. Pollack
- Urban Health Lab, University of Chicago, Chicago, USA
- Crown Family School of Social Work Policy and Practice, University of Chicago, 969 E 60th St, Chicago, IL 60637 USA
- Department of Public Health Sciences, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637 USA
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7
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Farquharson W, Schwartz JE, Klein DN, Carlson GA. Factors Associated With Police Bringing Children to a Psychiatric Emergency Room. Psychiatr Serv 2022; 74:488-496. [PMID: 36300282 DOI: 10.1176/appi.ps.202200028] [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 Sensational headlines describing police entanglements with young children have prompted questions about how often these incidents occur and why. The authors of this cross-sectional study examined the factors associated with police versus nonpolice arrivals to the psychiatric emergency room and those predicting subsequent police arrivals. METHODS Electronic medical records of children ages 5.0-12.9 years brought to a comprehensive psychiatric emergency program (CPEP) at a university hospital were reviewed to determine whether a child was brought by police ("police arrival") in response to a 911 call by school personnel, a mental health or other medical professional, or a caregiver. Extracted data included the child's age, sex, race-ethnicity, family makeup, insurance status, arrival status, referral source, diagnosis, disposition, treatment, number of CPEP and police encounters, and occurrences of aggression and suicidality. Multilevel and ordinary logistic regression models were used to identify factors associated with a first and subsequent police arrival. RESULTS Of 339 children with CPEP encounters from September 2017 to April 2018, 103 (30%) had had at least one police arrival. Children brought by police were more likely than peers brought by caregivers to be Black or Latinx, have Medicaid, come from families without two parents, and have aggressive outbursts or suicidal behavior. Results from multilevel logistic regression indicated that aggressive outbursts and suicidality were most significantly and consistently associated with experiencing both a first and subsequent police arrival. CONCLUSIONS Clinical and sociodemographic differences in police arrivals highlight the need for a comprehensive systems approach for children, especially marginalized youths, who need psychiatric emergency care.
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Affiliation(s)
- Wilfred Farquharson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Joseph E Schwartz
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Daniel N Klein
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Gabrielle A Carlson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
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Compton MT, Graves J, Zern A, Pauselli L, Anderson S, Ashekun O, Ellis S, Langlois S, Pope L, Watson AC, Wood J. Characterizing Arrests and Charges Among Individuals With Serious Mental Illnesses in Public-Sector Treatment Settings. Psychiatr Serv 2022; 73:1102-1108. [PMID: 35378991 PMCID: PMC11446468 DOI: 10.1176/appi.ps.202000581] [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] [Indexed: 11/30/2022]
Abstract
Objective Individuals with serious mental illnesses are overrepresented in all facets of the legal system. State-level criminal histories of patients with serious mental illnesses were analyzed to determine the proportion who had been arrested and number of lifetime arrests and charges, associations of six variables with number of arrests, and the most common charges from individuals’ first two arrests and most recent two arrests. Methods A total of 240 patients were recruited at three inpatient psychiatric facilities and gave consent to access their criminal history. Information was extracted from Record of Arrest and Prosecution (RAP) sheets for lifetime arrests in Georgia. Results A total of 171 (71%) had been arrested. Their mean±SD lifetime arrests were 8.6±10.1, and mean lifetime charges were 12.6±14.6. In a Poisson regression, number of arrests was associated with lower educational attainment, Black or African American race, the presence of a substance use disorder, the presence of a mood disorder, and female sex. Common early charges included marijuana possession, driving under the influence of alcohol, and burglary and shoplifting. Common recent charges included probation violations, failure to appear in court, officer obstruction–related charges, and disorderly conduct. Conclusions Findings point to a need for policy and program development in the legal system (e.g., pertaining to charges such as willful obstruction of an officer), the mental health community (e.g., to ensure that professionals know about clients’ legal involvement and can partner in strategies to reduce arrests), and social services sectors (to address charges, such as shoplifting, often related to material disadvantage).
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Affiliation(s)
- Michael T. Compton
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY
| | | | - Adria Zern
- Columbia University Vagelos College of Physicians and Surgeons, Department of Psychiatry, New York, NY
| | - Luca Pauselli
- Icahn School of Medicine at Mount Sinai, St. Luke’s/West Hospital Center, New York, NY
| | | | | | | | | | - Leah Pope
- Vera Institute of Justice, New York, NY
| | - Amy C. Watson
- University of Illinois at Chicago, Jane Addams College of Social Work, Chicago, IL
| | - Jennifer Wood
- Temple University, College of Liberal Arts, Philadelphia, PA
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Alvarez K, Polanco-Roman L, Breslow AS, Molock S. Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems. Am J Psychiatry 2022; 179:422-433. [PMID: 35599542 PMCID: PMC9765395 DOI: 10.1176/appi.ajp.21101001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Suicide rates among ethnoracially minoritized youth (i.e., youth of color) peak before the age of 30, and striking disparities in access to mental health services have been identified in this age group. However, suicide prevention strategies have yet to fully address structural racism as a mechanism in producing disparities in risk, protective factors, and access to quality effective intervention for youth of color. Such an approach is critical to provide more culturally responsive mental health care. Through an adapted socio-ecological model, the authors propose the Structural Racism and Suicide Prevention Systems Framework and illustrate pathways through which structural racism impacts suicide prevention and intervention for youth of color in the United States. The authors contextualize the impact of structural racism in three key settings where youth suicide prevention occurs: mental health services, schools, and the interface between crisis care and law enforcement. The authors posit that critical attention must be paid to the intersection of mutually reinforcing, interdependent systems rather than to systems in isolation. The authors then propose recommendations to address structural racism in suicide prevention, including macro-level interventions to improve societal conditions, research strategies to inform structural solutions, training approaches to address institutional racism, and clinical approaches to address the impact of racism and racial trauma on youths and families.
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Affiliation(s)
- Kiara Alvarez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA,Department of Medicine, Harvard Medical School, Boston, MA, USA,Correspondence: Kiara Alvarez, Massachusetts General Hospital Disparities Research Unit, Department of Medicine, 50 Staniford Street, Suite 830, Boston, MA 02114; ; Phone: 617-724-1237; Fax: 617-726-4120
| | | | - Aaron Samuel Breslow
- PRIME Center for Health Equity, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY,Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, USA
| | - Sherry Molock
- Department of Psychological & Brain Sciences, The George Washington University, Washington, DC
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Butler A, Zakimi N, Greer A. Total systems failure: police officers' perspectives on the impacts of the justice, health, and social service systems on people who use drugs. Harm Reduct J 2022; 19:48. [PMID: 35590421 PMCID: PMC9117855 DOI: 10.1186/s12954-022-00629-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/05/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Police in Canada have become main responders to behavioural health concerns in the community-a role that disproportionately harms people who use drugs (PWUD). Recent calls to defund the police emphasize the need to shift responsibility for non-criminal health issues from police to health and social services. This study explores the role of police interactions in responding to PWUD within the broader institutional and structural contexts in which they operate. METHODS We conducted a qualitative thematic analysis of interviews with sixteen police officers across nine jurisdictions in British Columbia, Canada. We examined police officers' everyday policing experiences interacting with PWUD, enforcing drug laws, and working alongside other service sectors. RESULTS Officers explained that the criminal justice system is one component of a wider network of systems that collectively fail to meet the needs of PWUD. They recognized that PWUD who interact with police often experienced intersecting structural vulnerabilities such as poverty, homelessness, and intergenerational trauma. Harmful drug laws in conjunction with inadequate treatment and housing resources contributed to a funnelling of PWUD into interactions with police. They provided several recommendations for reform including specialized health and justice roles, formalized intersectoral collaboration, and poverty reduction. CONCLUSIONS Overall, this study provides unique insights into the positioning and role of police officers within a "total systems failure" that negatively impact PWUD. Police have become responders-by-default for issues that are fundamentally related to people's health conditions and socioeconomic circumstances. Addressing failures across the health, social, and justice systems to meet the needs of PWUD will require an examination of the shortcomings across these systems, as well as substantial funding and system reforms.
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Affiliation(s)
- Amanda Butler
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Naomi Zakimi
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
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11
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Kamin D, Weisman RL, Lamberti JS. Promoting Mental Health and Criminal Justice Collaboration Through System-Level Partnerships. Front Psychiatry 2022; 13:805649. [PMID: 35178003 PMCID: PMC8844546 DOI: 10.3389/fpsyt.2022.805649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022] Open
Abstract
Recent high-profile deaths of unarmed individuals in police custody have raised concerns about the role of police officers in responding to people who are experiencing mental health crises. Of further concern, people with serious mental illness are highly over-represented throughout the entire criminal justice system including within jail, prison and community corrections populations. It is widely accepted that promoting mental health and criminal justice collaboration is a key to addressing these concerns. Promoting effective collaboration is challenging, however, due to fundamental differences in cultures and methods that exist between mental health and criminal justice service providers. To promote effective collaboration between service providers, a conceptual framework was recently published that divides the collaborative process into separate steps and outlines respective responsibilities at each step. Yet optimal collaboration between mental health and criminal justice service providers requires the support of their respective supervisors and agency heads. This paper extends previous work at the service provider level by applying the conceptual framework to promote effective collaboration at the systems level (i.e., between agencies). Barriers to inter-agency collaboration are discussed, and strategies for facilitating collaboration at each step of the collaborative process are presented.
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Affiliation(s)
- Don Kamin
- Institute for Police, Mental Health & Community Collaboration, Rochester, NY, United States
- Monroe County Office of Mental Health, Rochester, NY, United States
| | - Robert L. Weisman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| | - J. Steven Lamberti
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
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12
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Koziarski J. The effect of the COVID-19 pandemic on mental health calls for police service. CRIME SCIENCE 2021; 10:22. [PMID: 34660172 PMCID: PMC8503731 DOI: 10.1186/s40163-021-00157-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/23/2021] [Indexed: 05/07/2023]
Abstract
Drawing upon seven years of police calls for service data (2014-2020), this study examined the effect of the COVID-19 pandemic on calls involving persons with perceived mental illness (PwPMI) using a Bayesian Structural Time Series. The findings revealed that PwPMI calls did not increase immediately after the beginning of the pandemic in March 2020. Instead, a sustained increase in PwPMI calls was identified in August 2020 that later became statistically significant in October 2020. Ultimately, the analysis revealed a 22% increase in PwPMI calls during the COVID-19 pandemic than would have been expected had the pandemic not taken place. The delayed effect of the pandemic on such calls points to a need for policymakers to prioritize widely accessible mental health care that can be deployed early during public health emergencies thus potentially mitigating or eliminating the need for increased police intervention, as was the case here. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1186/s40163-021-00157-6.
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Affiliation(s)
- Jacek Koziarski
- Department of Sociology, University of Western Ontario, 1151 Richmond Street, London, ON N6A 3K7 Canada
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Affiliation(s)
- Meret S Hofer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Wilson Center for Science and Justice, Duke University School of Law, Durham, North Carolina
| | - Allison R Gilbert
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Wilson Center for Science and Justice, Duke University School of Law, Durham, North Carolina
| | - Marvin S Swartz
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, and Wilson Center for Science and Justice, Duke University School of Law, Durham, North Carolina
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