Sociodemographic and clinical factors associated with jail entry after a mental health crisis.

Individuals who experience mental health crises frequently find themselves in contact with the criminal legal system. Strengthening the capacity of mental health crisis services to engage with those at high risk for incarceration is a priority both for those who experience crises and those responsible for service delivery. This retrospective analysis included 10,269 mental health crisis episodes among 6861 individuals from 2021 to 2022 in San Francisco, California, USA. We examined the sociodemographic and episode-level characteristics most associated with incarceration in the county's jail within the 30 days following the crisis episode using logistic regression. Male gender and homelessness were independently associated with increased odds of incarceration in the 30 days following a crisis. In addition, being placed on an involuntary psychiatric hold was associated with increased odds of incarceration compared to episodes where no hold was initiated during the crisis. Having a crisis service delivered by the city's Street Crisis Response Team was also associated with increased odds of jail entry when compared to other service delivery options, as was any past-year crisis services utilization and another jail entry in the past year. These findings illustrate the challenges individuals experiencing homelessness and serious mental illness face when navigating life in an urban environment embodying multiple social stressors. As cities like San Francisco develop a more robust approach to supporting people with mental health concerns experiencing homelessness, it is essential to coordinate across sectors - including the criminal legal system, social services, and behavioral health - to promote better health outcomes.