Treatment for individuals involved with the criminal justice system to assess and prevent suicide risk

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

This study is testing a new way to help people in the criminal justice system who are at risk of suicide by using health and jail records to provide better support and treatment.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 1040 (estimated)
• Ages: 18 Years to 100 Years
• Sex: All
• Sponsor: Cambridge Health Alliance (Academic / other)
• Locations: 1 site (Cambridge, Massachusetts)
• Trial ID: NCT06564948 on ClinicalTrials.gov

What this trial studies

This initiative aims to utilize real-time data from health systems and criminal justice records to identify individuals frequently entering and exiting jail, focusing on suicide risk assessment and prevention. By coordinating care across these systems, the project seeks to address the challenges of tracking and intervening with this vulnerable population. The intervention includes standard treatment and additional support through the Family and Social Justice Service and Navigator program. The ultimate goal is to achieve a reduction in the suicide rate in the U.S.

Who should consider this trial

Good fit: Ideal candidates are individuals aged 18-100 from specific cities in the Cambridge Health Alliance catchment area with documented police involvement between 2009 and 2019.

Not a fit: Patients without any history of police involvement or those outside the specified age range may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly reduce suicide rates among individuals interacting with the criminal justice system.

How similar studies have performed: While the approach of linking health and criminal justice data for suicide prevention is innovative, similar studies have shown promise in improving mental health outcomes in related populations.

Eligibility criteria

Inclusion Criteria:

1. Treatment as Usual (TAU) arm

   1. Cambridge Health Alliance (CHA) patients from the cities other than Cambridge considered to be in the "catchment area" of CHA (Everett, Chelsea, Somerville, Medford, Malden, and Winthrop)
   2. Ages 18-100
   3. Identified as having police involvement between 2009 and 2019. Treatment as Usual patients will be identified using "targeted limited chart review methods" used in our prior studies, "scraping" clinical notes in the Electronic Health Records for criminal justice involvement. Initial Identification terms, "police", "arrest", "court", "summons", "jail", and "crime" will be used to identify candidates for police involvement, downloading the sentence in which the keyword appeared and the sentence before and after. Next, an iterative process of editing of the search terms will be conducted to remove patients with negation of the keyword ("did not commit a crime"), and other sentence characteristics that generate false positives ("cardiac arrest"). Samples of the resulting dataset will be taken, accuracy assessed by examining the surrounding sentences, leading to further iterations and repetition of the process until a high level of accuracy is achieved.
2. Family and Social Justice Section (FSJS) arm

   1. Cambridge Health Alliance patients from Cambridge
   2. Ages 18-100
   3. Individuals who have come into contact with the Cambridge Police Department (as identified in the Family and Social Justice Section data) between 2009 and 2025.
3. Family and Social Justice Section plus Navigator (FSJS+Navigator) arm

   1. Recruited during the study period in the CHA ED
   2. Ages 18-100
   3. Individuals who are brought into the Emergency Department under police supervision (excluding individuals currently incarcerated)

      * involuntarily brought to the Emergency Department for psychiatric evaluation because they are considered to be a risk to themselves or others (MA Law 123(12)); or
      * the subject of a police call for service for a mental health issue who are willingly admitted to the Emergency Department

Exclusion Criteria

1. Treatment as Usual (TAU) arm

   1. Cambridge Health Alliance patients residing in the City Cambridge are excluded from the TAU arm
   2. Under the age of 18
   3. Individuals with no identified criminal legal system contact during the study time period (no criminal legal involvement found in the targeted limited chart review method).
   4. Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2019).
2. Family and Social Justice Section (FSJS) arm

   1. Cambridge Health Alliance patients outside of Cambridge will be excluded from the FSJS arm
   2. Under the age of 18
   3. Any individual incarcerated at the Middlesex Jail/Prison that has not been released by the end of the period of data collection (December 31, 2019)
3. Family and Social Justice Section plus Navigator (FSJS+Navigator) arm

   1. Under the age of 18
   2. Any individual who becomes incarcerated during the course of the study
   3. Individuals who enter the Emergency Department not under police supervision

      * For example, individuals will be excluded who voluntarily come to the ED seeking psychiatric care because they feel they may be a risk to themselves or others
      * Individuals brought to the ED from a jail or court ordered to the ED as an alternative to jail or prison

Where this trial is running

Cambridge, Massachusetts

• Cambridge Health Alliance — Cambridge, Massachusetts, United States (Recruiting)

Study contacts

• Study coordinator: Benjamin Cook

Conditions Suicide Risk; Psychiatric Disorders