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Articles   |    
Costs of Criminal Justice Involvement Among Persons With Serious Mental Illness in Connecticut
Jeffrey W. Swanson, Ph.D.; Linda K. Frisman, Ph.D.; Allison Gilbert Robertson, Ph.D., M.P.H.; Hsiu-Ju Lin, Ph.D.; Robert L. Trestman, Ph.D., M.D.; Deborah A. Shelton, Ph.D., R.N.; Kathryn Parr, Ph.D.; Eleni Rodis, M.S.; Alec Buchanan, Ph.D., M.D.; Marvin S. Swartz, M.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.002212012
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Dr. Swanson, Dr. Robertson, and Dr. Swartz are affiliated with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, DUMC 3071, Durham, NC 27710 (e-mail: jeffrey.swanson@duke.edu). Dr. Frisman, Dr. Lin, Dr. Parr, and Ms. Rodis are with the Connecticut Department of Mental Health and Addiction Services, Hartford, and the University of Connecticut School of Social Work, West Hartford. Dr. Trestman is with the University of Connecticut Health Center, Farmington. Dr. Shelton is with the Office for Nursing Research, West Virginia University School of Nursing, Morgantown. Dr. Buchanan is with the Department of Psychiatry, Yale School of Medicine, New Haven.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  This study sought to describe patterns and costs of criminal justice involvement among adults with serious mental illness who received services across public agencies within a single state. Costs were examined from the perspective of state agencies providing mental health, substance abuse, and criminal justice services.

Methods  Administrative records for 25,133 adults who were served by the Connecticut Department of Mental Health and Addiction Services (DMHAS) during fiscal years 2006 and 2007 and who had a diagnosis of schizophrenia or bipolar disorder were matched with records of the state Medicaid program, Judicial Branch, Department of Correction, and Department of Public Safety. Unit costs for service events were combined with utilization data to calculate costs per person.

Results  About one in four individuals was involved with the justice system during the two-year period. The justice-involved group incurred costs approximately double those of the group with no involvement—$48,980 compared with $24,728 per person. Costs were shared by several state agencies and Medicaid. DMHAS bore the largest proportion of state service costs, covering 49% of total costs for persons with justice involvement and 69% of costs for those without involvement.

Conclusions  Criminal justice involvement is a complex and costly problem that affects a substantial proportion of adults with serious mental illness who receive services across state agencies. Applying per-person cost estimates in other states could help mental health and criminal justice systems to better plan, coordinate, and deliver cost-effective services to individuals with serious mental illness who become involved with the criminal justice system.

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Figure 1 State agency costs per person receiving each type of service for individuals with and without criminal justice system involvementa

a DMHAS, Department of Mental Health and Addiction Services; DSS, Department of Social Services; DOC, Department of Correction. Percentages in parentheses represent portions of the two samples (involved and not involved in the criminal justice system).

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Table 1Characteristics of persons with serious mental illness, by whether they were involved in the criminal justice systema
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a Significant difference between groups (p<.01) on all characteristics

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Table 2Type of criminal justice involvement and costs among 6,904 persons with serious mental illness who were involved with the justice system during fiscal years 2006 and 2007 combined
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a Estimated per-person costs apply only to persons with any utilization of each type of services.

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b Incarceration per diem costs include an estimate of Correctional Managed Health Care treatment costs.

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c The total estimated per-person cost for criminal justice services applies to all persons with any criminal justice service (N=6,904)

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Table 3Utilization and cost of services for individuals involved in the criminal justice system and those with no involvement
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a DMHAS, Department of Mental Health and Addiction Services; ConnPace, a state prescription medication program for the elderly and disabled populations.

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Table 4Mental health and criminal justice costs for individuals involved in the criminal justice system and those with no involvement, by state payer agencya
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a Costs are reported in 2007 dollars. DMHAS, Department of Mental Health and Addiction Services

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b Includes state and municipal law enforcement. Court involvement for persons not involved in the criminal justice system means civil procedures only.

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c Costs of behavioral health services provided within Department of Correction facilities are included in per-diem costs of incarceration.

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References

Glaze LE: Correctional Populations in the United States. Washington, DC, US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2009. Available at bjs.ojp.usdoj.gov/content/glance/tables/incrttab.cfm
 
James DJ, Glaze LE: Mental Health Problems of Prison and Jail Inmates. Washington, DC, US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2006. Available at www.ojp.usdoj.gov/bjs
 
Steadman  HJ;  Osher  FC;  Robbins  PC  et al:  Prevalence of serious mental illness among jail inmates.  Psychiatric Services 60:761–765, 2009
[CrossRef] | [PubMed]
 
Abram  KM;  Teplin  LA:  Co-occurring disorders among mentally ill jail detainees: implications for public policy.  American Psychologist 46:1036–1045, 1991
[CrossRef] | [PubMed]
 
Abram  KM;  Teplin  LA;  McClelland  GM:  Comorbidity of severe psychiatric disorders and substance use disorders among women in jail.  American Journal of Psychiatry 160:1007–1010, 2003
[CrossRef] | [PubMed]
 
West JC, Sabol WJ: Prisoners in 2007. Washington, DC, US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2008. Available at 222.oip.usdoj.gov/bis
 
Clear  TR;  Rose  DR;  Ryder  JA:  Incarceration and the community: the problem of removing and returning offenders.  Crime and Delinquency 47:335–351, 2001
[CrossRef]
 
Criminal Justice/Mental Health Consensus Project. New York, Council of State Governments, 2002. Available at consensusproject.org/downloads/Entire_report.pdf
 
Draine  J;  Salzer  MS;  Culhane  DP  et al:  Role of social disadvantage in crime, joblessness, and homelessness among persons with serious mental illness.  Psychiatric Services 53:565–573, 2002
[CrossRef] | [PubMed]
 
Frank  RG;  McGuire  TG:  Mental health treatment and criminal justice outcomes; in  Controlling Crime: Strategies and Tradeoffs . Edited by Cook  P;  Ludwig  J;  McCrary  J.  Chicago,  University of Chicago Press, 2011
 
Hartwell  S:  Female mentally ill offenders and their community reintegration needs: an initial examination.  International Journal of Law and Psychiatry 24:1–11, 2001
[CrossRef] | [PubMed]
 
Mallik-Kane K, Visher CA: Health and Prisoner Reentry: How Physical, Mental, and Substance Abuse Conditions Shape the Process of Reintegration. Washington, DC, Urban Institute, Justice Policy Center, 2008. Available at www.urban.org/UploadedPDF/411617_health_prisoner_reentry.pdf
 
Roman  CG;  McBride  EC;  Osborne  JWL:  Principles and Practice in Housing for Persons With Mental Illness Who Have Had Contact With the Justice System .  Washington, DC,  Urban Institute, Justice Policy Center, 2006
 
Wolff  N:  Community reintegration of prisoners with mental illness: a social investment perspective.  International Journal of Law and Psychiatry 28:43–58, 2005
[CrossRef] | [PubMed]
 
Wolff  N;  Draine  J:  Dynamics of social capital of prisoners and community reentry: ties that bind? Journal of Correctional Health Care 10:457–490, 2004
[CrossRef]
 
Clark  RE;  Ricketts  SK;  McHugo  GJ:  Legal system involvement and costs for persons in treatment for severe mental illness and substance use disorders.  Psychiatric Services 50:641–647, 1999
[PubMed]
 
State Mental Health Agency (SMHA), Mental Health Services Expenditures, FY2009. Menlo Park, Calif, Kaiser Family Foundation, 2010. Available at statehealthfacts.org/comparemaptable.jsp?ind=278&cat=5
 
Correctional Populations Health Care Expenditures. Menlo Park, Calif, Kaiser Family Foundation, 2003. Available at statehealthfacts.org/comparemaptable.jsp?ind=278&cat=5
 
Grading the States: A Report on America’s Health Care System for Adults with Serious Mental Illness. Alexandria, Va, National Alliance for Mental Illness, 2009. Available at www.nami.org/gtstemplate09.cfm?section=State_by_State09
 
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