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Howell BA, Hawks LC, Balasuriya L, Chang VW, Wang EA, Winkelman TNA. Health Insurance and Mental Health Treatment Use Among Adults With Criminal Legal Involvement After Medicaid Expansion. Psychiatr Serv 2023; 74:1019-1026. [PMID: 37016823 PMCID: PMC10939137 DOI: 10.1176/appi.ps.20220171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Individuals with criminal legal involvement have high rates of substance use and other mental disorders. Before implementation of the Affordable Care Act's Medicaid expansion, they also had low health insurance coverage. The objective of this study was to assess the impact of Medicaid expansion on health insurance coverage and use of treatment for substance use or other mental disorders in this population. METHODS The authors used restricted data (2010-2017) from the National Survey on Drug Use and Health (NSDUH). Using a difference-in-differences approach, the authors estimated the impact of Medicaid expansion on health insurance coverage and treatment for substance use or other mental disorders among individuals with recent criminal legal involvement. RESULTS The sample consisted of 9,910 NSDUH respondents who were ages 18-64 years, had a household income ≤138% of the federal poverty level, and reported past-year criminal legal involvement. Medicaid expansion was associated with an 18 percentage-point increase in insurance coverage but no change in receipt of substance use treatment among individuals with substance use disorder. Individuals with any other mental illness had a 16 percentage-point increase in insurance coverage but no change in receipt of mental health treatment. CONCLUSIONS Despite a large increase in health insurance coverage among individuals with criminal legal involvement and substance use or other mental disorders, Medicaid expansion was not associated with a significant change in treatment use for these conditions. Insurance access alone appears to be insufficient to increase treatment for substance use or other mental disorders in this population.
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Affiliation(s)
- Benjamin A Howell
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Laura C Hawks
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Lilanthi Balasuriya
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Virginia W Chang
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Emily A Wang
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
| | - Tyler N A Winkelman
- SEICHE Center for Health and Justice and Section of General Internal Medicine (Howell, Wang) and National Clinician Scholars Program (Balasuriya), Yale School of Medicine, New Haven; Division of General Internal Medicine and Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee (Hawks); Department of Social and Behavioral Sciences, School of Global Public Health, and Department of Population Health, Grossman School of Medicine, New York University, New York City (Chang); Health, Homelessness, and Criminal Justice Lab, Hennepin Healthcare Research Institute, and Division of General Internal Medicine, Department of Medicine, Hennepin Healthcare, Minneapolis (Winkelman)
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Howell BA, Wang EA, Winkelman TNA. Mental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act. Psychiatr Serv 2019; 70:765-771. [PMID: 31138056 DOI: 10.1176/appi.ps.201800559] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The objective of this study was to assess changes in health insurance coverage and mental health treatment among individuals with and without involvement in the criminal justice system after implementation of key provisions of the Affordable Care Act (ACA). METHODS Data from the National Survey on Drug Use and Health were used to assess changes in coverage, mental health treatment, and payer between 2011-2013 and 2014-2017 for nonelderly adults (ages 19 to 64) with and without criminal justice involvement in the past year who reported serious psychological distress. Multivariable logistic regression was used to obtain adjusted estimates. RESULTS The weighted sample represented, on average, 2.0 million individuals with criminal justice involvement (total unweighted N=3,688) and 20.9 million without criminal justice involvement (total unweighted N=33,872) in each study year. Following implementation of the ACA's key provisions, health insurance coverage increased by 13.4 percentage points (95% CI=8.5-18.3) among individuals with past year criminal justice involvement and by 8.1 percentage points (95% CI=6.9-9.4) among those without. Receipt of any mental health treatment did not change significantly among individuals with criminal justice involvement (-3.4 percentage points [95% CI=-8.0 to 1.1]), whereas it increased significantly in the general population (2.2 percentage points [95% CI=0.4-3.9]). CONCLUSIONS Despite an increase in health insurance coverage for people with criminal justice involvement, there was no increase in mental health treatment following implementation of the ACA's key provisions. Health insurance coverage is necessary, but not sufficient, to expand access to mental health treatment for individuals involved in the criminal justice system.
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Affiliation(s)
- Benjamin A Howell
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Emily A Wang
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
| | - Tyler N A Winkelman
- National Clinician Scholars Program, Yale School of Medicine, and U.S. Department of Veterans Affairs Connecticut Health Care System, New Haven, Connecticut (Howell); Division of General Internal Medicine, Yale School of Medicine, New Haven (Wang); Division of General Internal Medicine, Hennepin Healthcare, and Hennepin Healthcare Research Institute, Minneapolis (Winkelman)
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Schwartz RP, Mitchell MM, O’Grady KE, Kelly SM, Gryczynski J, Mitchell SG, Gordon MS, Jaffe JH. Pharmacotherapy for opioid addiction in community corrections. Int Rev Psychiatry 2018; 30:117-135. [PMID: 30522370 PMCID: PMC6551322 DOI: 10.1080/09540261.2018.1524373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/11/2018] [Indexed: 10/27/2022]
Abstract
Pharmacotherapy for opioid addiction with methadone, buprenorphine, and naltrexone has proven efficacy in reducing illicit opioid use. These treatments are under-utilized among opioid-addicted individuals on parole, probation, or in drug courts. This paper examines the peer-reviewed literature on the effectiveness of pharmacotherapy for opioid addiction of adults under community-based criminal justice supervision in the US. Compared to general populations, there are relatively few papers addressing the separate impact of pharmacotherapy on individuals under community supervision. Tentative conclusions can be drawn from the extant literature. Reasonable evidence exists that illicit opioid use and self-reported criminal behaviour decline after treatment entry, and that these outcomes are as favourable among individuals under criminal justice supervision as the general treatment population. Surprisingly, there is no conclusive evidence regarding the extent to which pharmacotherapy impacts the likelihood of arrest and incarceration among individuals under supervision. However, given the proven efficacy of these three medications in reducing illicit opioid use and the evidence that, in the general population, methadone and buprenorphine treatment are associated with reduction in overdose mortality, the use of all three pharmacotherapies among patients under criminal justice supervision should be expanded while more data are collected on their impact on arrest and incarceration.
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Affiliation(s)
| | | | - Kevin E. O’Grady
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Bhugra D. Italian psychiatry. Int Rev Psychiatry 2018; 30:117. [PMID: 29757030 DOI: 10.1080/09540261.2018.1435761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Dinesh Bhugra
- a Institute of Psychiatry , King's College London , London , UK.,b Past President of World Psychiatric Association , Switzerland
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Kennedy-Hendricks A, Huskamp HA, Rutkow L, Barry CL. Improving Access To Care And Reducing Involvement In The Criminal Justice System For People With Mental Illness. Health Aff (Millwood) 2018; 35:1076-83. [PMID: 27269025 DOI: 10.1377/hlthaff.2016.0006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
People with mental illness make up a disproportionate share of the criminal justice-involved population. The passage of critical new reforms affecting health care for vulnerable populations under the Affordable Care Act and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 presents unique opportunities to transform systems of care and avert criminal justice involvement. In addition, state and local jurisdictions have implemented a number of strategies to divert people with mental illness from the criminal justice system and reduce recidivism. In this article we summarize current knowledge about the involvement of people with mental illness in the criminal justice system and consider the recent opportunities presented by national and local policies that aim to lower the proportion of such people who are incarcerated.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Alene Kennedy-Hendricks is an assistant scientist in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Haiden A Huskamp
- Haiden A. Huskamp is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
| | - Lainie Rutkow
- Lainie Rutkow is an associate professor in the Department of Health Policy and Management, with a joint appointment in the Department of Health, Behavior, and Society, both at the Johns Hopkins Bloomberg School of Public Health
| | - Colleen L Barry
- Colleen L. Barry is a professor in the Department of Health Policy and Management, with a joint appointment in the Department of Mental Health, both at the Johns Hopkins Bloomberg School of Public Health, and is codirector of the Johns Hopkins Center for Mental Health and Addiction Policy Research
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Wildeman C, Wang EA. Mass incarceration, public health, and widening inequality in the USA. Lancet 2017; 389:1464-1474. [PMID: 28402828 DOI: 10.1016/s0140-6736(17)30259-3] [Citation(s) in RCA: 410] [Impact Index Per Article: 58.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/06/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022]
Abstract
In this Series paper, we examine how mass incarceration shapes inequality in health. The USA is the world leader in incarceration, which disproportionately affects black populations. Nearly one in three black men will ever be imprisoned, and nearly half of black women currently have a family member or extended family member who is in prison. However, until recently the public health implications of mass incarceration were unclear. Most research in this area has focused on the health of current and former inmates, with findings suggesting that incarceration could produce some short-term improvements in physical health during imprisonment but has profoundly harmful effects on physical and mental health after release. The emerging literature on the family and community effects of mass incarceration points to negative health impacts on the female partners and children of incarcerated men, and raises concerns that excessive incarceration could harm entire communities and thus might partly underlie health disparities both in the USA and between the USA and other developed countries. Research into interventions, policies, and practices that could mitigate the harms of incarceration and the post-incarceration period is urgently needed, particularly studies using rigorous experimental or quasi-experimental designs.
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Affiliation(s)
- Christopher Wildeman
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA; Bureau of Justice Statistics, Washington, DC, USA; Rockwool Foundation Research Unit, Copenhagen, Denmark.
| | - Emily A Wang
- Yale School of Medicine, New Haven, CT, USA; Bureau of Justice Assistance, Washington, DC, USA
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Swartz JA, Tabahi S. Community-Based Mental Health Treatment Preceding Jail Detention among Adults with Serious Mental Illness. INTERNATIONAL JOURNAL OF FORENSIC MENTAL HEALTH 2017; 16:104-116. [PMID: 34234625 PMCID: PMC8259790 DOI: 10.1080/14999013.2016.1255283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Research on the effectiveness of community-based mental health treatment for offenders with a serious mental illness (SMI) has lacked specifics on the type and intensity of services received. This study examined the detailed lifetime and past-year community mental health treatment use of 431 (282 men; 149 women) jail detainees with SMI. Whereas a majority of participants reported high lifetime rates of mental health treatment they believed effective, treatment in the year and month prior to arrest and detention was accessed by only a minority of the sample. Where gender differences were found, women were less likely to receive treatment than men and more likely to leave treatment against medical advice in the year preceding arrest. Both substance use disorders and post-traumatic stress disorder (PTSD) were significantly undertreated for both genders, and care was provided predominantly by psychiatrists suggesting an underuse of other mental health professionals. The implications for expanding treatment availability for offenders, particularly women, with an emphasis on broadening access to ancillary but critical services such as literacy training, housing and employment services, and case management provided by mental health professionals in conjunction with services provided by psychiatrists are discussed.
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Affiliation(s)
- James A Swartz
- University of Illinois at Chicago, Jane Addams College of Social Work, 1040 W. Harrison Street, MC 309, Chicago, IL. 600607
| | - Suhad Tabahi
- University of Illinois at Chicago, Jane Addams College of Social Work, 1040 W. Harrison Street, MC 309, Chicago, IL. 600607
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Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014. J Gen Intern Med 2016; 31:1523-1529. [PMID: 27638837 PMCID: PMC5130958 DOI: 10.1007/s11606-016-3845-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of justice-involved individuals have mental health issues and substance use disorders (SUD) that are often untreated due to high rates of uninsurance. However, roughly half of justice-involved individuals were estimated to be newly eligible for health insurance through the Affordable Care Act (ACA). OBJECTIVE We aimed to assess health insurance trends among justice-involved individuals before and after implementation of the ACA's key provisions, the dependent coverage mandate and Medicaid expansion, and to examine the relationship between health insurance and treatment for behavioral health conditions. DESIGN Repeated and pooled cross-sectional analyses of data from the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS Nationally representative sample of 15,899 adults age 19-64 years between 2008 and 2014 with a history of justice involvement during the prior 12 months. MAIN MEASURES Uninsurance rates between 2008 and 2014 are reported. Additional outcomes include adjusted treatment rates for depression, serious mental illness, and SUD by insurance status. KEY RESULTS The dependent coverage mandate was associated with a 13.0 percentage point decline in uninsurance among justice-involved individuals age 19-25 years (p < 0.001). Following Medicaid expansion, uninsurance declined among justice involved individuals of all ages by 9.7 percentage points (p < 0.001), but remained 16.3 percentage points higher than uninsurance rates for individuals without justice involvement (p < 0.001). In pooled analyses, Medicaid, relative to uninsurance and private insurance, was associated with significantly higher treatment rates for illicit drug abuse/dependence and depression. CONCLUSION Given the high prevalence of mental illness and substance use disorders among justice-involved populations, persistently elevated rates of uninsurance and other barriers to care remain a significant public health concern. Sustained outreach is required to reduce health insurance disparities between individuals with and without justice involvement. Public insurance appears to be associated with higher treatment rates, relative to uninsurance and private insurance, among justice-involved individuals.
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Nowotny KM, Cepeda A, James-Hawkins L, Boardman JD. Growing Old Behind Bars: Health Profiles of the Older Male Inmate Population in the United States. J Aging Health 2015; 28:935-56. [PMID: 26553724 DOI: 10.1177/0898264315614007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study examines patterns of multimorbidity among elderly male inmates across four domains of health (chronic medical conditions, drug- and alcohol-related diseases, impairments, and mental and behavioral health) to understand the complex health care needs of this growing population. METHOD We use the 2004 Survey of Inmates in State Correctional Facilities and Latent Class Regression Analysis to examine 22 health problems among 1,026 men aged 50 and older. RESULTS There are four groups of elderly male inmates: (a) relatively healthy (45.1%), (b) substance users with behavioral health issues (23.4%), (c) chronic unhealthy with impairments and violence/injury (23.6%), and (d) very unhealthy across all domains (7.9%). These groups have unique sociodemographic background and incarceration history characteristics. CONCLUSION This study demonstrates the complexity of health for elderly inmates. Prison health should continue to be monitored to aid correctional and community health programs in understanding clinical risks, exposures, and health care needs for this population.
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Affiliation(s)
| | - Alice Cepeda
- University of Southern California, Los Angeles, USA
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10
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Rosenberg L. Setting the Table for Change. J Behav Health Serv Res 2014; 41:406-7. [DOI: 10.1007/s11414-014-9427-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Karakus MC. Affordable Care Act and behavioral health services: special section editor's note. J Behav Health Serv Res 2014; 41:408-9. [PMID: 24938932 DOI: 10.1007/s11414-014-9421-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mustafa C Karakus
- Westat, Health Studies, 1600 Research Blvd., Rockville, MD, 20850, USA,
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