Ford Elizabeth B, Silverman Kevin D, Solimo Angela, Leung Y Jude, Smith Allison M, Bell Connor J, Katyal Monica
Correctional Health Services, NYC Health + Hospitals, New York.
Psychiatr Serv. 2020 Jun 1;71(6):547-554. doi: 10.1176/appi.ps.201900405. Epub 2020 Feb 11.
New York City's (NYC) Correctional Health Services has introduced specialized treatment units for patients with serious mental illness in the NYC jail system. With multidisciplinary mental health staffing and a coordinated approach with NYC's Department of Correction, these units expand therapeutic options for patients vulnerable to clinical instability and physical harm, including those at high risk of psychiatric medication nonadherence and those returning to jail from psychiatric hospitalization. This study evaluated the extent to which these units improve clinical outcomes for this population.
This retrospective, observational cohort study included adult males with serious mental illness with a length of jail stay of ≥14 days between January 1, 2016, and March 31, 2018. Patients on treatment units were matched with patients of similar characteristics (control group) by using propensity score matching (N=302 pairs). Rates of self-injury, injury due to violence, and psychiatric medication adherence were analyzed.
Most patients on treatment units had diagnoses of schizophrenia spectrum and other psychotic disorders (81%), and most had a violent felony as their most severe charge (68%). Compared with patients in a control group, those on the treatment units had lower rates per 100 person-days of injury due to violence at 30 and 60 days (0.04, 95% confidence interval [CI]=0.02-0.07, and 0.03, 95% CI=0.02-0.06, respectively) and higher mean medication adherence (77% versus 55%, p<0.001). They also experienced lower rates of self-injury, although the difference was not statistically significant.
Initial outcomes indicate substantial benefits to patients, demonstrating the value of a rehabilitative approach to psychiatric care in jail.
纽约市惩教卫生服务局在纽约市监狱系统中为患有严重精神疾病的患者引入了专门的治疗单元。通过多学科心理健康人员配置以及与纽约市惩教部的协调方法，这些单元为易出现临床不稳定和身体伤害的患者扩展了治疗选择，包括那些有精神科药物治疗依从性高风险的患者以及从精神病院住院治疗后返回监狱的患者。本研究评估了这些单元在多大程度上改善了该人群的临床结局。
这项回顾性观察队列研究纳入了2016年1月1日至2018年3月31日期间在监狱停留时间≥14天的患有严重精神疾病的成年男性。通过倾向得分匹配（N = 302对）将治疗单元中的患者与具有相似特征的患者（对照组）进行匹配。分析了自我伤害、暴力导致的伤害以及精神科药物治疗依从率。
治疗单元中的大多数患者被诊断为精神分裂症谱系及其他精神病性障碍（81%），并且大多数人最严重的指控是暴力重罪（68%）。与对照组患者相比，治疗单元中的患者在30天和60天时每百人日暴力导致的伤害发生率较低（分别为0.04，95%置信区间[CI]=0.02 - 0.07，以及0.03，95% CI = 0.02 - 0.06），平均药物治疗依从性较高（77%对55%，p < 0.001）。他们的自我伤害发生率也较低，尽管差异无统计学意义。
初步结果表明对患者有显著益处，证明了在监狱中采用康复性精神科护理方法的价值。
