Treatment of Mental Illness Lowers Arrest Rates, Saves Money

Research from North Carolina State University, RTI International (RTI) and the University of South Florida shows that outpatient treatment of mental illness significantly reduces arrest rates for people with mental health problems and saves taxpayers money.

“This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society,” says Dr. Sarah Desmarais, an assistant professor of psychology at NC State and co-author of a paper describing the research.

The researchers wanted to determine the extent to which treating mental illness can keep people with mental health problems out of trouble with the law. It is well established that people with mental health problems, such as schizophrenia or bipolar disorder, make up a disproportionate percentage of defendants, inmates and others who come into contact with the criminal justice system.

The researchers identified 4,056 people who had been hospitalized for mental illness in 2004 or 2005 and then tracked them from 2005 to 2012. The researchers were able to determine which individuals were receiving government-subsidized medication and which were receiving government-subsidized outpatient services, such as therapy. The researchers were also able to determine who was arrested during the seven-year study period.

“Our research shows that people receiving medication were significantly less likely to be arrested,” Desmarais says. “Outpatient services also resulted in a decreased likelihood of arrest.”

The researchers also compared criminal justice costs with mental health treatment costs. Individuals who were arrested received less treatment and each cost the government approximately $95,000 during the study period. Individuals who were not arrested received more treatment and each cost the government approximately $68,000 during the study period.

“It costs about $10 less per day to provide treatment and prevent crime. That’s a good investment,” Desmarais says.

The paper, “Effects of Outpatient Treatment on Risk of Arrest of Adults With Serious Mental Illness and Associated Costs,” was published online May 15 in the journal Psychiatric Services. Lead author of the paper is Dr. Richard Van Dorn of RTI. Co-authors include John Petrila, Diane Haynes and Dr. Jay Singh of the University of South Florida. The research was supported by the Florida Agency for Health Care Administration.

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Note to Editors: The study abstract follows.

“Effects of Outpatient Treatment on Risk of Arrest of Adults With Serious Mental Illness and Associated Costs”

Authors: Richard A. Van Dorn, Research Triangle Institute; Sarah L. Desmarais, North Carolina State University; John Petrila, Diane Haynes and Jay P. Singh, University of South Florida

Published: Online May 2013, Psychiatric Services

DOI: 10.1176/appi.ps.201200406

Abstract: Objective: This study examined whether possession of psychotropic medication and receipt of outpatient services reduce the likelihood of posthospitalization arrest among adults with serious mental illness. A secondary aim was to compare service system costs for individuals who were involved with the justice system and those who were not. Methods: Claims data for prescriptions and treatments were used to describe patterns and costs of outpatient services between 2005 and 2012 for 4,056 adult Florida Medicaid enrollees with schizophrenia or bipolar disorder after discharge from an index hospitalization. Multivariable time-series analysis tested the effects of medication and outpatient services on arrest (any, felony, or misdemeanor) in subsequent 30-day periods. Results: A total of 1,263 participants (31%) were arrested at least once during follow-up. Monthly medication possession and receipt of outpatient services reduced the likelihood of any arrests (misdemeanor or felony) and of misdemeanor arrests. Possession of medications for 90 days after hospital discharge also reduced the likelihood of arrest. Prior justice involvement, minority racial-ethnic status, and male sex increased the risk of arrest, whereas older age decreased it. Criminal justice and behavioral health system costs were significantly higher for the justice-involved group than for the group with no justice involvement. Conclusions: Routine outpatient treatment, including medication and outpatient services, may reduce the likelihood of arrest among adults with serious mental illness. Medication possession over a 90-day period after hospitalization appears to confer additional protection. Overall, costs were lower for those who were not arrested, even when they used more outpatient services.