Connections Health Solutions, Tucson, Arizona (Balfour); Department of Psychiatry, University of Arizona, Tucson (Balfour); public sector consultant, Carolina Beach, North Carolina (Hahn Stephenson); Council of State Governments Justice Center, New York City (Delany-Brumsey); Tucson Police Department, Tucson, Arizona (Winsky); San Francisco Department of Public Health, San Francisco (Goldman); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Goldman).
Psychiatr Serv. 2022 Jun;73(6):658-669. doi: 10.1176/appi.ps.202000721. Epub 2021 Oct 20.
How a community responds to behavioral health emergencies is both a public health issue and social justice issue. Individuals experiencing a behavioral health crisis often receive inadequate care in emergency departments (EDs), boarding for hours or days while waiting for treatment. Such crises also account for a quarter of police shootings and >2 million jail bookings per year. Racism and implicit bias magnify these problems for people of color. Growing support for reform provides an unprecedented opportunity for meaningful change, but solutions to this complex issue will require comprehensive systemic approaches. As communities grapple with behavioral health emergencies, the question is not just law enforcement should respond to behavioral health emergencies but to reduce unnecessary law enforcement contact and, if law enforcement is responding, , , and . This policy article reviews best practices for law enforcement crisis responses, outlines the components of a comprehensive continuum-of-crisis care model that provides alternatives to law enforcement involvement and ED use, and offers strategies for collaboration and alignment between law enforcement and clinicians toward common goals. Finally, policy considerations regarding stakeholder engagement, financing, data management, legal statutes, and health equity are presented to assist communities interested in taking steps to build these needed solutions.
社区如何应对行为健康紧急情况既是一个公共卫生问题，也是一个社会公正问题。在急诊部 (ED)，经历行为健康危机的个人往往得不到充分的护理，他们要等待数小时甚至数天才能得到治疗。这些危机也占警察枪击事件的四分之一和每年超过 200 万次的监禁预订。种族主义和隐性偏见使有色人种的这些问题更加严重。对改革的日益支持为有意义的变革提供了前所未有的机会，但要解决这一复杂问题，需要采取全面的系统方法。随着社区应对行为健康紧急情况，问题不仅在于执法部门是否应该应对行为健康紧急情况，还在于减少不必要的执法接触，如果执法部门正在做出反应，那么还需要确保其迅速、适当、高效和有同情心。本文回顾了执法部门危机应对的最佳实践，概述了一个全面的危机护理连续模型的组成部分，该模型提供了替代执法部门参与和使用急诊部的选择，并提供了执法部门和临床医生之间为实现共同目标进行合作和协调的策略。最后，提出了关于利益相关者参与、融资、数据管理、法律法规和健康公平的政策考虑因素，以帮助有兴趣采取措施建立这些必要解决方案的社区。
