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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
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. wihawthorne@ucsd.edu
William B
WB
Hawthorne
David P
DP
Folsom
David H
DH
Sommerfeld
Nicole M
NM
Lanouette
Marshall
M
Lewis
Gregory A
GA
Aarons
Richard M
RM
Conklin
Ellen
E
Solorzano
Laurie A
LA
Lindamer
Dilip V
DV
Jeste
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002140:California / Q000453:epidemiology; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data; D028642:Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D016019:Survival Analysis; D013997:Time Factors