Abstract
BackgroundIndividuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. This study assessed the prevalence of encounters with the criminal justice system, encounter types, and the estimated cost attributable to these encounters in the one-year treatment of persons with schizophrenia.MethodsThis post-hoc analysis used data from a prospective one-year cost-effectiveness study of persons treated with antipsychotics for schizophrenia and related disorders in the United States. Criminal justice system involvement was assessed using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). Direct cost of criminal justice system involvement was estimated using previously reported costs per type of encounter. Patients with and without involvement were compared on baseline characteristics and direct annual health care and criminal justice system-related costs.ResultsOverall, 278 (46%) of 609 participants reported at least 1 criminal justice system encounter. They were more likely to be substance users and less adherent to antipsychotics compared to participants without involvement. The 2 most prevalent types of encounters were being a victim of a crime (67%) and being on parole or probation (26%). The mean annual per-patient cost of involvement was $1,429, translating to 6% of total annual direct health care costs for those with involvement (11% when excluding crime victims).ConclusionsCriminal justice system involvement appears to be prevalent and costly for persons treated for schizophrenia in the United States. Findings highlight the need to better understand the interface between the mental health and the criminal justice systems and the related costs, in personal, societal, and economic terms.
Highlights
Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs
Studies of the cost of schizophrenia in the United States have typically not included costs associated with legal encounters [5,6,7,8,9], data from non-US studies suggest that encounters with the criminal justice system constitute a substantial proportion of indirect costs [10,11]
Participants with criminal justice system involvement were significantly younger (p < .001), had a poorer level of mental health functioning (p < .001), were more likely to have been hospitalized in the prior year (p = .003), to use emergency services (p = .021), to have a lifetime diagnosis of substance abuse disorder (p < .001), to drink alcohol to intoxication (p = .049), and to use cannabis and cocaine (p < .001)
Summary
Individuals with schizophrenia may have a higher risk of encounters with the criminal justice system than the general population, but there are limited data on such encounters and their attendant costs. In the United States each year, approximately 1 million detentions in county jails involve persons with serious mental illnesses. These individuals are imprisoned about 8 times more frequently than they are admitted to state mental hospitals [1] and are incarcerated for significantly longer time than other inmates [2]. Persons with schizophrenia are known to have a higher risk of arrest and incarceration compared with the general population [3], many of their other legal contacts result from being victimized by others rather than from unlawful behavior on their part [4]. One study estimated that the overall annual (2002) US cost of schizophrenia includes $2.64 billion in direct non-health care costs for law enforcement [12]
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