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: 2.41). 01/2012; 63(1):26-32. DOI: 10.1176/
Source: PubMed


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.

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    • "There are also data indicating that differences in race or ethnicity are related to rates of violence (Mason, Medford, & Peters, 2012), although the nature of these differences has yet to be adequately explained (Bruce, Cobb, Clisby, Ndegwa, & Hodgins, 2014). Part of the discrepancy may reflect findings of higher rates of psychotic disorders, substance abuse, and violence in marginalized groups experiencing chronic social defeat (Selten, Van Der Ven, Rutten, & Cantor-Graae, 2013; Staub, 1996), as well as racial differences in rates of commitment to psychiatric versus forensic settings (Hawthorne et al., 2012) that can affect treatment opportunities and outcomes, subsequent victimization experiences, and longitudinal course. "
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