Article

Incarceration among adults who are in the public mental health system: rates, risk factors, and short-term outcomes.

Department of Psychiatry, Advanced Center for Innovation in Services and Intervention Research, University of California, San Diego, 9500 Gilman Dr., MC 0664, La Jolla, CA 92093-0664, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.81). 01/2012; 63(1):26-32. DOI: 10.1176/appi.ps.201000505
Source: PubMed

ABSTRACT Incarceration of people with mental illness has become a major social, clinical, and economic concern, with an estimated 2.1 million incarcerations in 2007. Prior studies have primarily focused on mental illness rates among incarcerated persons. This study examined rates of and risk factors for incarceration and reincarceration, as well as short-term outcomes after incarceration, among patients in a large public mental health system.
The data set included 39,463 patient records combined with 4,544 matching incarceration records from the county jail system during fiscal year 2005-2006. Risk factors for incarceration and reincarceration were analyzed with logistic regression. Time after release from the index incarceration until receiving services was examined with survival analysis.
During the year, 11.5% of patients (N=4,544) were incarcerated. Risk factors for incarceration included prior incarcerations; co-occurring substance-related diagnoses; homelessness; schizophrenia, bipolar, or other psychotic disorder diagnoses; male gender; no Medicaid insurance; and being African American. Patients older than 45, Medicaid beneficiaries, and those from Latino, Asian, and other non-Euro-American racial-ethnic groups were less likely to be incarcerated. Risk factors for reincarceration included co-occurring substance-related diagnoses; prior incarceration; diagnosed schizophrenia or bipolar disorder; homelessness; and incarceration for three or fewer days. Patients whose first service after release from incarceration was outpatient or case management were less likely to receive subsequent emergency services or to be reincarcerated within 90 days.
Modifiable factors affecting incarceration risk include homelessness, substance abuse, lack of medical insurance, and timely receipt of outpatient or case management services after release from incarceration.

0 Bookmarks
 · 
183 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Forensic Medical Service of the Public Health Service offers health care to detainees in police cells in Amsterdam. This study describes the registered mental health, addiction and social problems and compares them to the self-reported problems among a sample of detainees. Registers of the Forensic Medical Service are related to information from registers of police detention episodes. A general assessment of substance use, mental health and social problems is obtained by interviewing a sample of 264 detainees. The Forensic Medical Service was contacted in 24% of the 17,321 detention episodes. In 14% of the episodes mental or substance related disorders were observed. Within the sample 59% scored positively on indicators of substance abuse or mental health problems, 35% had additional social problems (debts, unemployment, housing). This proportion increased with age. It is concluded that substance abuse and mental health problems combined with social problems are highly prevalent among detainees, especially among the older ones. This urges for a close cooperation between Public Mental Health Care and Forensic Medical Services.
    Journal of Forensic and Legal Medicine 07/2014; 25:55-9. DOI:10.1016/j.jflm.2014.04.015 · 0.99 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: People with severe mental illness and a co-occurring substance use disorder (co-occurring disorders) who live in urban areas experience high rates of incarceration. This study examined sociodemographic, clinical, economic, and community integration factors as predictors of incarceration among people with co-occurring disorders. Methods: This secondary analysis used data from a randomized controlled trial of assertive community treatment versus standard case management. In the parent study, researchers interviewed 198 people with co-occurring disorders from two urban mental health centers in Connecticut at baseline and every six months for three years. Researchers tracked incarceration, clinical engagement and status, employment, living situation, social relationships, and substance use. The study reported here used bivariate analyses and logistic regression analyses to compare individuals who were incarcerated during the study period with those who were not. Results: The overall incarceration rate was 38% during the study period. In multivariate analyses, prior incarceration predicted incarceration during the study period (odds ratio [OR]=3.26). Two factors were associated with a reduced likelihood of incarceration: friendships with individuals who did not use substances (OR=.19) and substance use treatment engagement (OR=.60) Conclusions: Positive social relationships and engagement in substance use treatment are promising service and policy targets to prevent incarceration in this high-risk population.
    Psychiatric services (Washington, D.C.) 07/2014; 65(11). DOI:10.1176/appi.ps.201300408 · 2.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many with schizophrenia tend to experience problems with the legal system. Yet little is still known about the correlates of the history of incarceration, as well as frequency of misdemeanor and felony convictions within community samples. To explore this question, we gathered legal and substance abuse histories, and assessments of symptoms and neurocognitive function from 96 adults in a nonacute phase of schizophrenia. ANOVA revealed history of incarceration to be linked with more severe drug and alcohol abuse histories, and greater positive symptoms. Greater numbers of misdemeanor convictions were linked to more severe drug and alcohol abuse histories and greater levels of disorganized symptoms, whereas a greater number of felony convictions was only associated with more severe drug abuse histories. A stepwise multiple regression revealed that both the severity of severe drug abuse histories and levels of disorganized symptoms contributed to predicting 24% of the variance in the number of reported lifetime misdemeanor offenses.
    Journal of Forensic Psychiatry and Psychology 06/2013; 24(3):293-308. DOI:10.1080/14789949.2013.776617 · 0.88 Impact Factor