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Analysis Underscores Financial Burden of Mental
Illness On Criminal Justice and Health Care Systems
Philadelphia, PA, November 11, 2009 –
Results from a large, retrospective analysis of inmates with a
serious mental illness (SMI) underscores the financial burden of
mental illness on the criminal justice and health and human
services (HHS) systems, and may provide useful information to
policy makers. The results of the analysis, which evaluated
patterns of arrest, utilization of services, and corresponding
expenditures among nearly 3,800 inmates in a large urban county of
Florida, were presented this week at the 137th
American Public Health Association (APHA) Annual Meeting &
Exposition.
The estimated number of adults with a SMI incarcerated each year is
approaching one million.1 Few jails have adequate funding to provide
appropriate mental health care for these inmates. As a result, many
may receive inadequate treatment and cause management and financial
problems while incarcerated. Improved understanding of these
individuals, and their diverse histories, problems and needs, may
help in developing effective policies and programs.
Analyses from the retrospective data assessed these issues and
sought to better understand trends among inmates with a SMI.
"The large size of the studied population allows us to identify
trends, which along with other information, could be used to impact
public sector expenditures associated with individuals with a SMI
who have contact with the criminal justice system." said Robert
Constantine, PhD, Associate Professor of Mental Health Law and
Policy, University of South Florida, who moderated the session at
APHA. "Specifically, this valuable knowledge can be used to create
more targeted mental health programming."
At the APHA meeting, researchers presented an overview and selected
findings from the Florida data set. The analysis evaluated criminal
justice and HHS histories, as well as associated costs to state and
local systems, of 3,769 individuals with a SMI.
Key Results and Conclusions
All analyses used data from the County criminal justice system to
identify individuals in local jails during fiscal year 2003 - 2004.
Participants were followed for one year prior and two years
following that timeframe. A variety of state (Medicaid, mental
health authority) and local (County health, social service) data
sets were used to identify which of these individuals had a SMI.
One analysis looked at patterns of utilization and costs for
individuals in this population. Cluster analysis was used along
with utilization data to identify groups with similar patterns
within and across behavioral health and criminal justice systems.
Per capita and aggregate service costs for each group were also
determined.
While aggregated costs for criminal justice and HHS were comparable
in subjects with a SMI, individual patterns differed significantly.
Of note, only 6 percent of those subjects studied with a SMI
incurred almost half of the total behavioral health care costs of
all subjects with a SMI, including almost two-thirds of inpatient
and emergency costs, while also incurring above-average criminal
justice costs. Characteristics most strongly and independently
associated with this high-intensity service pattern were being
older, being male, having been diagnosed with psychotic, bipolar,
or substance abuse disorder, and having a history of homelessness.
The analysis concluded that distinguishing subpopulations with
substantially different profiles of involvement in criminal justice
and HHS systems may help in identifying differential strategies for
intervention.
Another analysis using the same data set looked at arrest patterns
in subgroups of individuals with a SMI, and evaluated differences
in the characteristics of these individuals. Latent class growth
and multinomial logistic regression analyses were used. Three
sub-groups were identified: 1) a group with little or no recidivism
beyond the index year, 2) a group with a consistent arrest pattern
of about one-half arrest per year, and 3) a group averaging just
over four arrests per year. Compared to participants with low/no
recidivism, those with some and high recidivism were more likely to
be relatively young, men, homeless, and with fewer outpatient and
more ER/inpatient mental health contacts. Participants with the
highest recidivism were also more likely to have a psychotic, as
opposed to Bipolar 1 disorder, and be substance abusers, whereas
those with some recidivism were least likely to have undergone an
involuntary psychiatric examination. The analysis concluded that
identification of sub-populations with different risks of arrests
over time provides useful information to policy makers regarding
the differential targeting of resources designed to reduce the risk
of arrest and increase treatment access.
Ortho-McNeil Janssen Scientific Affairs, LLC provided funding to
the University of South Florida/Florida Mental Health Institute
(FMHI) for the research study.
About Serious Mental Illness (SMI)
Serious Mental Illness encompasses individuals with schizophrenia,
schizoaffective disorder, other psychotic disorders, bipolar 1
disorder, and major depressive or other bipolar and mood disorders.
Within the study population, 22 percent of the inmates had
psychotic disorders, inclusive of schizophrenia, 29 percent had
bipolar 1 disorder, and 31 percent had major depression. These
disorders can lead to substantial interference with life
activities, basic daily living skills, and functioning in social,
family, and vocational/education contexts.
About Janssen
Janssen®, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.,
is based in Titusville, N.J., and is the only large pharmaceutical
company in the U.S. dedicated solely to mental health. It currently
has prescription medications for the treatment of schizophrenia,
bipolar mania, and the treatment of symptoms associated with
autistic disorders. Ortho-McNeil-Janssen Pharmaceuticals, Inc. is a
member of the Johnson & Johnson family of companies. For more
information about Janssen, visit www.janssen.com.
References
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