Thursday, September 14, 2023

Study Explores Factors Driving Health Care Use Among Those Involved With Criminal Legal System

It is well-known that people with mental health and substance use disorders are more likely to interact with the criminal legal system than those without these disorders. A report in Psychiatric Services now suggests mental health disorders may be a stronger factor than substance use disorders in these individuals seeking health services.

“[O]ur findings suggest that interventions that address a broad range of behavioral health needs for individuals with mental illness will be important to reduce acute health care use among those with criminal legal involvement,” wrote Harini Shah, Laura Hawks, M.D., M.P.H., and colleagues at the Medical College of Wisconsin.

Shah, Hawks, and colleagues analyzed data from the annual National Survey on Drug Use and Health (NSDUH), collected between 2015 and 2019. They identified 9,039 community-dwelling adults 18 years and over who indicated they had been arrested, on probation, and/or on parole/supervised release in the past year. They then examined the relationship between mental illness, substance use disorder, or both and the adults’ use of health care services. Health care services encompassed emergency department visits, outpatient medical visits, and inpatient hospital stays.

Compared with individuals with neither disorder, those with mental illness had an average of 1.46 times as many outpatient visits, 1.43 times as many emergency department visits, and 2.14 times as many days spent in inpatient care. Individuals with comorbid mental illness and substance use disorder had 1.62 times as many emergency department visits and 4.16 times as many inpatient days as those with neither disorder. Individuals with only substance use disorder had 1.23 times as many emergency department visits relative to individuals with neither mental health nor substance use disorders.

The authors noted all the calculations factored in social and demographic variables such as race, age, employment status, and income, suggesting that these traits have very little influence on the link between mental illness and health care utilization.

“The observed increases in [emergency department] and inpatient utilization among those with mental illness suggest opportunities for enhancing access to ambulatory care, improving care coordination, and increasing available resources,” the authors wrote.

To read more on this topic, see the Psychiatric News article “Community MH Must Include Care for Incarcerated Individuals, Released Prisoners.”

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