Abstract
BackgroundA subgroup of individuals becomes entrenched in a “revolving door” involving corrections, health, and social welfare services. Little research has investigated the numbers of people that are in frequent contact with multiple public agencies, the costs associated with these encounters, or the characteristics of the people concerned. The present study used linked administrative data to examine offenders who were also very frequent users of health and social services. We investigated the magnitude and distribution of costs attributable to different categories of service for those in the top 10 % of sentences to either community or custodial settings. We hypothesized that the members of these subgroups would be significantly more likely to have substance use and other mental disorders than other members of the offender population.MethodsData were linked across agencies responsible for services to the entire population of British Columbia spanning justice, health, and income assistance. Individuals were eligible for inclusion in the study if they were sentenced at least once in the Vancouver Provincial Court between 2003 and 2012. We examined the subset of participants who fell within the top 10 % of sentences and at least two of the following service categories: community physician services; hospital days; pharmaceutical costs; or income assistance between 2007 and 2012. We examined two groups of offenders separately (those in the top ten percent sentenced to community supervision or to custody) due to differences in time at risk and availability to receive community-based services.ResultsFrom more than 14,000 offenders sentenced in Vancouver’s Downtown Eastside, very High Frequency service users associated with community (n = 216) and custody (n = 107) sentences incurred average attributable public service costs of $168,000 and $247,000 respectively over a 5-year period of observation. Health-related costs for both groups were over $80,000 per person, primarily associated with hospital admissions. Across both groups, 99 % had been diagnosed with at least one mental disorder and over 80 % had co-occurring substance use and another mental disorder.ConclusionsA subset of offenders with concurrent psychiatric disorders receives extremely high levels of service from health, social welfare, and justice sectors in close temporal succession. Members of this subpopulation require targeted supports in order to produce positive outcomes and prevent the perpetuation of a costly and ineffective revolving door.Electronic supplementary materialThe online version of this article (doi:10.1186/s12982-015-0040-9) contains supplementary material, which is available to authorized users.
Highlights
A subgroup of individuals becomes entrenched in a “revolving door” involving corrections, health, and social welfare services
Canadian research demonstrates that offenders with co-occurring substance use and mental disorders are at significantly higher risk of being reconvicted than other offenders, including those with mental disorders alone [2]
Of those not included in the High Frequency (HF) Community group (n = 14,156), 41 % had no diagnosis, 19 % had a mental disorder diagnosis, 11 % had a substance-related diagnosis, and the remaining 29 % had both a substance related and a nonsubstance related mental disorder diagnosis
Summary
A subgroup of individuals becomes entrenched in a “revolving door” involving corrections, health, and social welfare services. Very few studies have examined the costs associated with individual offenders based on their involvement with public agencies and services. Researchers examining the histories of offenders with both substance use and mental disorders have reported: “few studies have been designed to investigate what types and amounts of treatment this population consumes” [13]. It is unclear how different forms of health service use influence the risk of recidivism, or the characteristics of those participants most likely to become involved with high rates of health and correctional services. Identifying the characteristics of offenders who are High Frequency service users may have implications for the promotion of health as well as public safety, establishing needs for targeted supports in order to promote recovery and prevent further recidivism
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