Integrated multisystem analysis in a mental health and criminal justice ecosystem.
BACKGROUND
Patients with a serious mental illness often receive care that is fragmented due to reduced availability of or access to resources, and inadequate, discontinuous, and uncoordinated care across health, social services, and criminal justice organizations. This article describes the creation of a multisystem analysis that derives insights from an integrated dataset including patient access to case management services, medical services, and interactions with the criminal justice system.


METHODS
Data were combined from electronic systems within a US mental health ecosystem that included mental health and substance abuse services, as well as data from the criminal justice system. Cox models were applied to test the associations between delivery of services and re-incarceration. Additionally, machine learning was used to train and validate a predictive model to examine effects of non-modifiable risk factors (age, past arrests, mental health diagnosis) and modifiable risk factors (outpatient, medical and case management services, and use of a jail diversion program) on re-arrest outcome.


RESULTS
An association was found between past arrests and admission to crisis stabilization services in this population (N = 10,307). Delivery of case management or medical services provided after release from jail was associated with a reduced risk for re-arrest. Predictive models linked non-modifiable and modifiable risk factors and outcomes and predicted the probability of re-arrests with fair accuracy (area under the receiver operating characteristic curve of 0.67).


CONCLUSIONS
By modeling the complex interactions between risk factors, service delivery, and outcomes, systems of care might be better enabled to meet patient needs and improve outcomes.
ODH, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA. Erin.Falconer@ODHsolutions.com.
Erin
E
Falconer
IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825, Israel.
Tal
T
El-Hay
IBM Global Business Services, 1475 Phoenixville Pike, West Chester, PA, 19380, USA.
Dimitris
D
Alevras
ODH, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA.
John P
JP
Docherty
IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825, Israel.
Chen
C
Yanover
IBM Research, Catholic University of Eastern Africa, P.O Box 62157 Bogani E Rd, Nairobi, Kenya.|Present Address: Ernst & Young, 1 Maagplatz, 8005, Zürich, Switzerland.
Alan
A
Kalton
IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825, Israel.
Yaara
Y
Goldschmidt
IBM Research, IBM R&D Labs in Israel, Haifa University Campus, Mount Carmel, Haifa, 3498825, Israel.
Michal
M
Rosen-Zvi
Arrest; Criminal justice system; Healthcare system; Hospitalization; Risk factors; Serious mental illness