Legal system involvement and costs for persons in treatment for severe mental illness and substance use disorders.
OBJECTIVE
Persons with co-occurring severe mental illness and substance use disorders were followed for three years to better understand how they are involved with the legal system and to identify factors associated with different kinds of involvement.


METHODS
Data came from a three-year study of 203 persons enrolled in specialized treatment for dual disorders. Cost and utilization data were collected from multiple data sources, including police, sheriffs and deputies, officers of the court, public defenders, prosecutors, private attorneys, local and county jails, state prisons, and paid legal guardians.


RESULTS
Over three years 169 participants (83 percent) had contact with the legal system, and 90 (44 percent) were arrested at least once. Participants were four times more likely to have encounters with the legal system that did not result in arrest than they were to be arrested. Costs associated with nonarrest encounters were significantly less than costs associated with arrests. Mean costs per person associated with an arrest were $2,295, and mean costs associated with a nonarrest encounter were $385. Combined three-year costs averaged $2,680 per person. Arrests and incarcerations declined over time. Continued substance use and unstable housing were associated with a greater likelihood of arrest. Poor treatment engagement was associated with multiple arrests. Men were more likely to be arrested, and women were more likely to be the victims of crime.


CONCLUSIONS
Effective treatment of substance use among persons with mental illness appears to reduce arrests and incarcerations but not the frequency of nonarrest encounters. Stable housing may also reduce the likelihood and number of arrests.
Clark
R E
RE
New Hampshire-Dartmouth Psychiatric Research Center, Dartmouth Medical School, Department of Community and Family Medicine, Hanover 03755-3862, USA. robin.e.clark@dartmouth.edu
Ricketts
S K
SK
McHugo
G J
GJ
D000328:Adult; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D003415:Crime / Q000191:economics / Q000706:statistics & numerical data; D019548:Crime Victims / Q000191:economics / Q000706:statistics & numerical data; D003416:Criminal Law / Q000191:economics; D017831:Diagnosis, Dual (Psychiatry) / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007603:Jurisprudence; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000191:economics / Q000453:epidemiology; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D016495:Police / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000150:complications / Q000191:economics / Q000453:epidemiology / Q000628:therapy