Artificial Intelligence-Based Student Activity Monitoring for Suicide Risk: Considerations for K-12 Schools, Caregivers, Government, and Technology Developers

In response to the widespread youth mental health crisis, some kindergarten-through-12th-grade (K-12) schools have begun employing artificial intelligence (AI)-based tools to help identify students at risk for suicide and self-harm. The adoption of AI and other types of educational technology to partially address student mental health needs has been a natural forward step for many schools during the transition to remote education. However, there is limited understanding about how such programs work, how they are implemented by schools, and how they may benefit or harm students and their families. To assist policymakers, school districts, school leaders, and others in making decisions regarding the use of these tools, the authors address these knowledge gaps by providing a preliminary examination of how AI-based suicide risk monitoring programs are implemented in K-12 schools, how stakeholders perceive the effects that the programs are having on students, and the potential benefits and risks of such tools. Using this analysis, the authors also offer recommendations for school and district leaders; state, federal, and local policymakers; and technology developers to consider as they move forward in maximizing the intended benefits and mitigating the possible risks of AI-based suicide risk monitoring programs.

Evaluation of Mental Health First Aid in New York City

More than 155,000 New Yorkers were trained in Mental Health First Aid (MHFA) between 2016 and 2020. Free citywide trainings were made available to all New Yorkers and were disseminated through city agencies and community-based settings. RAND Corporation researchers conducted a mixed-methods study that included a web-based survey of past trainees and a series of focus groups with leaders of community-based organizations and city agency staff to assess the impact of the MHFA trainings and needs for future training. In this article, the authors describe the evaluation activities that took place; the methods behind them; and the results at the individual, agency, and community levels. They also offer recommendations for ways to improve future mental health education efforts. Respondents applied MHFA skills extensively and broadly across their social networks. Nine in ten respondents had contact with an individual with a mental health problem in the past six months. Among those who had contact, 84 percent indicated using their MHFA skills to help a friend or family member, and nearly half reported applying skills with a co-worker, neighbor, or acquaintance. Because MHFA was offered through city agency workplaces and community-based settings, tens of thousands of New Yorkers were given tools to come to the aid of individuals in their personal and professional lives. MHFA may be a promising approach to building supportive social networks, organizations, and communities that are primed to recognize and assist those experiencing mental health challenges.

Just in Reach Pay for Success: Impact Evaluation and Cost Analysis of a Permanent Supportive Housing Program

Discharging individuals from jails and prisons who may be poorly equipped for independent living-such as those with a history of chronic health conditions, including serious mental illness-is likely to reinforce a pattern of homelessness and recidivism. Permanent supportive housing (PSH)-which combines a long-term housing subsidy with supportive services-has been proposed as a mechanism to intervene directly on this relationship between housing and health. In Los Angeles County, jail has become a default housing and services provider to unhoused individuals with serious mental health issues. In 2017, the county initiated the Just in Reach Pay for Success (JIR PFS) project, which provided PSH as an alternative to jail for individuals with a history of homelessness and chronic behavioral or physical health conditions. The authors of this study assessed whether the project led to changes in use of several county services, including justice, health, and homeless services. The authors examined changes in county service use, before and after incarceration, by JIR PFS participants and a comparison control group and found that use of jail services was significantly reduced after JIR PFS PSH placement, while the use of mental health and other services increased. The researchers assess that the net cost of the program is highly uncertain but that it may pay for itself in terms of reducing the use of other county services and therefore provide a cost-neutral means of addressing homelessness among individuals with chronic health conditions involved with the justice system in Los Angeles County.

The Help-Seeking Experiences of Family and Friends Who Support Young People With Mental Health Issues: A Qualitative Study

Little has been documented of the journey that family and friends (F&F) undertake when supporting a young person aged 12-25 years struggling with mental illness. The experiences of family and friends were explored using an online qualitative survey (N = 58) and semi-structured interviews (n = 15). Recruitment was through a national youth mental health service Facebook page and website. An experiential thematic analysis was conducted focusing on participants' experiences and sense of their world.Strong feelings and challenging life circumstances made the context of help-seeking complicated. Despite following usual avenues for advice or support, F&F still came across professionals and a health/mental health system that compounded their distress. It was the simpler things that some professionals did that made their journey more bearable. Useful insights derived from the narratives allow service improvement recommendations such as reminding professionals of the multiplicity of stressors commonplace to families and the value of validation and acknowledgement.

A Process Evaluation of Primary Care Behavioral Health Integration in the Military Health System

Behavioral health (BH) problems are common in the military and can adversely affect force readiness. Research suggests that primary care-behavioral health (PCBH) integration can improve BH outcomes by making high-quality BH care available in more accessible settings. However, sustaining high-quality implementation of PCBH is challenging. The authors conducted a process evaluation of the PCBH program in the military health system to understand why the program is working as it is and provide recommendations for quality improvement. They conducted semistructured interviews, rigorously coded the qualitative data to identify causal links, and created and validated causal loop diagrams that provide a visualization of how the system is working. Findings fall into four key areas: staffing and capabilities, valued tasks, program stewardship, and fostering program awareness and support. Overall, the authors found that the PCBH program is highly valued by primary care staff. However, the PCBH care model is inconsistently adhered to, owing to a combination of staff preferences, local pressures, and lack of knowledge of PCBH staff roles. Recommendations are offered to improve program implementation.

Assessing Health and Human Services Needs to Support an Integrated Health in All Policies Plan for Prince George's County, Maryland

With evolving demographics and a changing health system landscape, the Prince George's County Council, acting as the County Board of Health, is considering its future policy approaches and resource allocations related to health and well-being. To inform this path forward, the authors of this study used primary and secondary data to describe both the health needs of county residents and drivers of health within the county, inclusive of the social, economic, built, natural, and health service environments. This study integrates these findings, an analysis of budget documents, and a review of promising practices from other communities to situate recommendations in a Health in All Policies framework to foster aligned and integrated planning and budgeting across the county to promote health and well-being. Findings from the assessment indicate a shared interest among leaders and residents to embrace a holistic strategy for health and well-being in the county. Inefficient uses of the health care system are identified, highlighting a need to rebalance investments in health care use and drivers of health. Additionally, challenges in navigating health and human services and inequities in drivers of health across communities are noted, signaling broader concerns related to residents' access to health and human services that influence health and well-being outcomes. Recommendations are provided for several paths forward for the county to pursue a more integrated policy approach to influence health and well-being outcomes.

Contemporary Issues in Gun Policy: Essays from the RAND Gun Policy in America Project

In this article, part of RAND's Gun Policy in America project, the authors describe the nuanced picture relating mental illness with gun violence. For example, suicide risk is elevated among people with certain mental illnesses, but suicide among those with such diagnoses is still rare. Homicide risk is also elevated among people with certain mental conditions (e.g., schizophrenia) and among people with co-occurring mental health conditions and substance use disorders, but these individuals still account for the minority of homicides and acts of mass violence in the United States. On the other hand, people with mental health conditions appear to be at increased risk for being victims of interpersonal violence.

Employee Engagement in the NHS: A Secondary Data Analysis of the NHS Healthy Workforce and Britain's Healthiest Workplace Surveys

Staff health and wellbeing is an important area for employers. Leading a healthy life, both physically and mentally, helps the individual health of employees, but also benefits employers through boosting productivity in the workplace. The Five Year Forward View strategy, published by NHS England in 2014, underscores the importance of staff health and wellbeing as a crucial factor in improving the performance of the NHS and chief executive Simon Stevens announced a number of new initiatives and policy developments aimed at improving health and wellbeing within the workforce in 2015. RAND Europe conducted an independent study to examine the factors associated with engagement among NHS employees as part of a project with the Health Foundation, a charity committed to bringing about better health and healthcare in the UK. RAND Europe analysed data from the NHS Healthy Workforce Survey, conducted in 2016 across 35 UK NHS organisations, as well as VitalityHealth's Britain's Healthiest Workplace (BHW) survey in 2016, which involved RAND Europe's analysis of the survey results. The views expressed in the study are the authors' own and do not necessarily represent the views of the Health Foundation.

2015 Department of Defense Health Related Behaviors Survey (HRBS)

The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's flagship survey for understanding the health, health-related behaviors, and well-being of service members. In 2014, the Defense Health Agency asked the RAND Corporation to review previous iterations of the HRBS, update survey content, administer a revised version of the survey, and analyze data from the resulting 2015 HRBS of active-duty personnel, including those in the U.S. Air Force, Army, Marine Corps, Navy, and Coast Guard. This study details the methodology, sample demographics, and results from that survey in the following domains: health promotion and disease prevention; substance use; mental and emotional health; physical health and functional limitations; sexual behavior and health; sexual orientation, transgender identity, and health; and deployment experiences and health. The results presented here are intended to supplement data already collected by the Department of Defense and to inform policy initiatives to help improve the readiness, health, and well-being of the force.

Transforming Urgent and Emergency Care and the Vanguard Initiative: Learning from Evaluation of the Southern Cluster

Urgent and Emergency Care (UEC) vanguards aim to improve the quality, efficiency and effectiveness of UEC services so that patients receive the most appropriate care at the right time and in the right place, and so that unnecessary admissions to accident and emergency (A&E) and hospitals are reduced. The Southern Cluster comprises three such UEC vanguards. RAND Europe's evaluation examined the impacts of the vanguards, the processes underpinning delivery (and associated enablers and challenges), and implications for future policy and practice. The evaluation used a multi-method approach, including theories of change, document review, workshops, interviews, surveys and data dashboards. The Southern Cluster UEC vanguards have made progress across core activities. Clinical hubs are operational across the sites. Direct booking capacity into primary care is progressing more with out-of-hours than with in-hours services. Gradual but variable progress has been made towards joint planning and governance of UEC services. Efforts to ensure seamless data sharing between providers, and interoperable IT infrastructure are progressing somewhat slower than originally hoped. Vanguard funding, committed leadership and practical mechanisms to support joint working helped drive progress. Public engagement, workforce-capacity and data interoperability will need to be addressed for longer-term impact at scale. The study makes recommendations concerning: (i) UEC health and care workforce capacity-building, (ii) local-national coordination around UEC transformation, (iii) collaboration across localities and professions, (iv) support for an end-to-end UEC pathway with mutually reinforcing activities, (v) cost and outcome data, (vi) an interoperable data infrastructure, and (vii) capacity for evaluation and learning.

Bibliometric Analysis of Mental Health Research: 1980--2008

This article presents the findings of a bibliometric study of mental health research papers published from 1980 to 2008. The aim of this study was to map mental health research in the G20 and other leading countries in order to analyse i) the research productivity of nations; ii) the relative intensity of research; iii) the level of research (clinical or basic); iv) levels of scientific impact; and v) levels of collaboration. This work is the result of a collaboration between Observatoire des sciences et des technologies in Montreal and RAND Europe.

Racial and Ethnic Differences in Mental Illness Stigma and Discrimination Among Californians Experiencing Mental Health Challenges

Reports racial and ethnic differences on the California Well-Being Survey, a surveillance tool that tracks mental illness stigma and discrimination among a sample of California adults experiencing psychological distress.

The Deployment Life Study: Longitudinal Analysis of Military Families Across the Deployment Cycle

In 2009, RAND launched the Deployment Life Study, a longitudinal study of military families across a deployment cycle in order to assess family readiness. Family readiness refers to the state of being prepared to effectively navigate the challenges of daily living experienced in the unique context of military service. The study surveyed families at frequent intervals throughout a complete deployment cycle---before a service member deploys (sometimes months before), during the actual deployment, and after the service member returns (possibly a year or more after she or he redeployed). It assessed a number of outcomes over time, including: the quality of marital and parental relationshipsthe psychological, behavioral, and physical health of family memberschild and teen well-being (e.g., emotional, behavioral, social, and academic)military integration (e.g., attitudes toward military service, retention intentions).This culminating paper briefly reviews the study design and data collection procedures, presents results from analyses of the longitudinal data collected from some 2,700 military families, and offers recommendations for programs and future research related to military families. The research was jointly sponsored by the Office of the Surgeon General, U.S. Army, and by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

Preventing, Identifying, and Treating Prescription Drug Misuse Among Active-Duty Service Members

Prescription drug misuse (PDM) is of critical concern for the military because of its potential impact on military readiness, the health and well-being of military personnel, and associated health care costs. The purpose of this study is to summarize insights gleaned from a series of activities that the RAND Corporation undertook for the Deputy Assistant Secretary of Defense for Readiness to address this important health and military readiness issue. The authors completed a review of U.S. Department of Defense policies and a comprehensive literature review of clinical guidelines and the empirical literature on the prevention and treatment of PDM and conducted individual face-to-face interviews with 66 health and behavioral health care providers at nine medical treatment facilities across three regions within the contiguous United States to identify best practices in the prevention, identification, and treatment of PDM and the extent to which those practices are known and followed. The study also presents the framework of an analytic tool that, once informed by data available to the military but not available to the authors, can assist the military in predicting future trends in PDM based on current demographics of active-duty service members and rates of injury and prescribing of prescription drugs. The findings from this work led the authors to formulate a set of key insights that they believe might improve the rapid identification and treatment of service members dealing with PDM, thereby improving future force readiness.

A Preliminary Evaluation of Interactive Video Simulation Training for Campus Law Enforcement in California

This article evaluates the Interactive Video Simulation Training to help campus law enforcement professionals refer and intervene with college students experiencing psychological distress.