Incarceration Among Adults Who Are in the Public Mental Health System
William B. Hawthorne, Ph.D., Gergory A. Aarons, Ph.D., David P. Folsom, M.D., Richard M. Conklin, LCSW., David H. Sommerfeld, Ph.D., Ellen Solorzano, MSW., Nicole M. Lanouette, M.D., Laurie A. Lindamer, Ph.D., Marshall Lewis, MD, Dilip V. Jeste, MD.

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 metnal 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 analysed 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-occuring 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-occuring substance-related diagnoses; prior incarceration; diagnosed schizophrenia or bipolar disorder; homelessness; and incarceration for theree or fewer days.    Patients whose first service after release from incarceration was outpaitent or case management were less likely to receive subsequient  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. 

(Psychiatric Services 63:26-32, 2012)