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Brief Reports   |    
Predictors of Unmet Need for Medical Care Among Justice-Involved Persons With Mental Illness
Anna Durbin, M.P.H.; Frank Sirotich, Ph.D.; Janet Durbin, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300301
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Ms. Durbin is with the Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada. Dr. Sirotich is with the Department of Community Support Services and Research, Canadian Mental Health Association, Toronto Branch. Dr. Durbin is with the Provincial System Support Program, Centre for Addiction and Mental Health, Toronto. Send correspondence to Dr. Sirotich (e-mail: frank.sirotich@utoronto.ca).

Copyright © 2014 by the American Psychiatric Association


Objective  This cross-sectional study examined factors associated with unmet need for care from primary care physicians or from psychiatrists among clients enrolled in mental health court support programs in Toronto, Ontario.

Methods  The sample included adults admitted to these programs during 2009 (N=994). Both measures of unmet need were determined by mental health court workers at program intake. Predictors included client predisposing, clinical, and enabling variables.

Results  Twelve percent had unmet need for care from primary care physicians and 34% from psychiatrists. Both measures of unmet need were associated with having an unknown diagnosis, having no income source or receiving welfare, homelessness, and not having a case manager. Unmet need for care from psychiatrists was associated with symptoms of serious mental illness and current hospitalization.

Conclusions  Obtaining care from psychiatrists appears to be a particular challenge for justice-involved persons with mental illness. Policies and practices that improve access warrant more attention.

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Table 1Correlates of unmet need for primary care physicians and for psychiatrists among 994 adults enrolled in mental health court support programs in Toronto, Ontario
Table Footer Note

a Model diagnostics were used to detect specification (nonsignificant) that indicated no evidence of omitted relevant variables and no evidence that the link function was not correctly specified. The Hosmer and Lemeshow goodness-of-fit statistics suggested that the models fit the data. The model predicting need for primary care physicians correctly classified at a rate of 87% (Nagelkerke R2=.1008). The model predicting need for psychiatrists correctly classified at a rate of 70% (Nagelkerke R2=.0913).

Table Footer Note

b Nonpsychotic disorders include depression, bipolar disorder, anxiety disorders, substance use disorders, and personality disorders. Psychotic disorders include schizophrenia, schizoaffective disorder, delusional disorder, and psychosis not otherwise specified.

Table Footer Note

c Eligibility for public disability benefits is based on need and requires endorsement by a physician. Private income sources included family, private insurance, and employment. Other income sources included employment insurance, pension revenue, and unknown sources.

Table Footer Note

d Charge severity was categorized as class 1, 2, or 3 according to the Ontario Ministry of the Attorney General categorization of offenses (used to determine eligibility for diversion). A higher class number indicates a more serious charge.



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