Mental health services utilization of people with symptoms of mental illness with and without involvement in the criminal justice system: Correlates and estimators to help guide policy and service development.

摘要

Background and significance. Minimal research exists describing mental health services utilization (MHSU) of persons with mental illness living in the community who have been arrested or are on probation. The single estimate in the literature (Ditton, 1999) is that 56% receive mental health services (MHS). This dissertation provides the first estimate using nationally representative data of MHSU of mentally ill persons comparing those arrested, on probation, both arrested and on probation, and with no criminal justice system involvement. This is important because the best practices literature recommends increasing MHSU to prevent arrest or recidivism. These estimates can therefore serve as a baseline comparison for developing public health interventions.;Methods. Three research questions were addressed: (1) Does being arrested, being on probation, or both concurrently affect probability and frequency of MHSU? (2) How well does a MHSU model explain service utilization? (3) In such a model, which variables are most influential? The 2001 National Household Survey on Drug Abuse (NHSDA) was used to develop and test a model of MHSU for both probability (n = 6436) and frequency of use. The final model includes independent variables for socioeconomic characteristics, social behaviors, mental illness severity, and social functioning.;Results. Probability of MHSU for mentally ill persons with no criminal justice system involvement (22.9%) approached the best national estimate for the entire U.S. adult population (23%). Arrested-only and probation-only groups had lower probability of use (18.6% per group) while those both arrested and on probation had the highest (26.9%). Among MHS users, arrested-only had the lowest frequency of use (mean of 1.64 visits) and probation-only and both arrested and on probation had the highest (means of 2.59 and 3.37 visits, respectively). Being both arrested and on probation was significantly associated with probability of MHSU (p = .023). Probation-only was significantly related to frequency of use among service users (p = .027).;Conclusion. While mentally ill persons who have been both arrested and on probation have the highest probability of MHSU, their probability of use is still far short of 100%. Future research should focus on examining this population and developing public health interventions to increase the proportion receiving services.