Symptoms and Decisions: Psychosis and Police-Led Psychiatric Crisis Intervention Outcomes

This study examined how the presence of psychotic symptoms affects police decision-making during behavioral health crisis interventions, with a focus on outcomes of jail diversion, emergency department (ED) diversion, and involuntary hold.

This study aimed to compare intervention patterns for individuals with and without psychotic presentations and to identify demographic, clinical, and operational factors associated with outcomes across groups.

A retrospective analysis of 50,062 police-led crisis encounters recorded in the Massachusetts Department of Mental Health's jail diversion program database between April 2023 and January 2025 was conducted, using stratified mixed-effects logistic regression with program location as a random effect.

Psychosis was present in 22.8% of all encounters and was associated with similar rates of jail diversion (87.9% vs. 84.7%) and ED diversion (43.1% vs. 54.3%), and higher rates of involuntary hold (26.1% vs. 11.5%). Assessment in home or community settings was associated with increased ED diversion across populations, while the presence of on-scene emergency or support personnel predicted involuntary hold. Among those with psychosis, charge severity, referral source, and prior police contact were associated with jail diversion, while mood disorder had a stronger association with involuntary hold in the non-psychosis group.

Findings highlight the need for population-specific crisis response protocols that integrate clinical features, setting, and referral dynamics. Structured decision-making tools, co-response models, and expanded consultation roles for mental health professionals, including psychiatric nurses, may improve alignment between individual needs and intervention outcomes.