High-Frequency Use of Corrections, Health & Social Services & Association with Mental Illness & Substance Use

BACKGROUND:

A subgroup of individuals becomes entrenched in a "revolving door" involving corrections, health, and social welfare services. Little research has investigated the numbers of people that are in frequent contact with multiple public agencies, the costs associated with these encounters, or the characteristics of the people concerned. The present study used linked administrative data to examine offenders who were also very frequent users of health and social services. We investigated the magnitude and distribution of costs attributable to different categories of service for those in the top 10 % of sentences to either community or custodial settings. We hypothesized that the members of these subgroups would be significantly more likely to have substance use and other mental disorders than other members of the offender population.

METHODS:

Data were linked across agencies responsible for services to the entire population of British Columbia spanning justice, health, and income assistance. Individuals were eligible for inclusion in the study if they were sentenced at least once in the Vancouver Provincial Court between 2003 and 2012. We examined the subset of participants who fell within the top 10 % of sentences and at least two of the following service categories: community physician services; hospital days; pharmaceutical costs; or income assistance between 2007 and 2012. We examined two groups of offenders separately (those in the top ten percent sentenced to community supervision or to custody) due to differences in time at risk and availability to receive community-based services.

RESULTS:

From more than 14,000 offenders sentenced in Vancouver's Downtown Eastside, very High Frequency service users associated with community (n = 216) and custody (n = 107) sentences incurred average attributable public service costs of $168,000 and $247,000 respectively over a 5-year period of observation. Health-related costs for both groups were over $80,000 per person, primarily associated with hospital admissions. Across both groups, 99 % had been diagnosed with at least one mental disorder and over 80 % had co-occurring substance use and another mental disorder.

CONCLUSIONS:

A subset of offenders with concurrent psychiatric disorders receives extremely high levels of service from health, social welfare, and justice sectors in close temporal succession. Members of this subpopulation require targeted supports in order to produce positive outcomes and prevent the perpetuation of a costly and ineffective revolving door.

Table 3

Rate ratio estimates of High Frequency Community Supervision compared to all other offenders

Variables	High Frequency Community Supervision (n = 216), Rate PP/PY	All Other Offenders (n = 14,156), Rate PP/PY	Unadjusted Rate Ratioa	Adjusted Rate Ratio (95 % CI)b
Any offence	1.6	0.6	2.5	2.9 (2.3, 3.6)
Property offence	0.8	0.3	3.2	3.6 (2.6, 4.9)
Breach offence	0.4	0.2	2.5	3.5 (2.4, 5.0)
Violent offence	0.2	0.1	2.0	2.2 (1.8, 2.8)
Community supervision daysd	253.0	70.6	3.6	3.6 (3.4, 3.9)
Days in custodyc	31.7	18.4	1.7	2.9 (1.9, 4.3)
MSP services	94.7	27.0	3.5	3.2 (2.9, 3.5)
MSP costsd ($CAD)	3170.3	768.0	4.1	3.9 (3.5, 4.3)
Acute hospital admissions	1.1	0.2	5.7	5.7 (4.6, 6.9)
Hospital daysd	11.3	1.7	6.8	6.6 (5.2, 8.3)
Prescription costsd ($CAD)	3493.1	552.3	6.3	6.4 (5.5, 7.5)
# of social assistance payments	11.6	4.5	2.6	2.5 (2.3, 2.8)
Social assistance payments ($CAD)	10284.5	3432.5	3.0	3.0 (2.6, 3.4)

MSP Medical services plan

aRate was calculated based on time at risk (exposure time-custody day). Unadjusted Rate Ratio was calculated from the rate for HF Community by dividing the rate of the non-HF Community

bNegative binomial regression analysis was conducted to obtain Adjusted Rate Ratio after controlling the effects of time at risk and socio-demographics (age, gender ethnicity and education level). Confidence intervals were estimated using Robust Standard Errors

cCalculation was based on the entire exposure time, not by time at risk

dVariables used to determine community High Frequency user groups

Table 4

Rate ratio estimates of High Frequency Custody compared to all other offenders

Variables	High Frequency Custody (n = 107), Rate PP/PY	All Other Offenders (n = 14,265), Rate PP/PY	Unadjusted Rate Ratioa	Adjusted Rate Ratio (95 % CI)b
Any offence	4.4	0.6	7.2	7.4 (6.0, 9.0)
Property offence	2.2	0.3	8.5	8.8 (6.5, 11.8)
Breach offence	1.3	0.2	8.6	10.0 (7.3, 13.8)
Violent offence	0.5	0.1	5.1	5.6 (3.9, 8.1)
Community supervision days	186.6	72.6	2.6	2.6 (2.2, 3.1)
Days in custodyc,d	118.2	17.9	6.6	8.8 (6.5, 11.9)
MSP services	128.0	27.4	5.9	4.6 (4.0, 5.3)
MSP costsc ($CAD)	4580.8	782.6	4.2	6.0 (5.3, 6.9)
Acute hospital admissions	2.0	0.2	10.5	11.2 (8.6, 14.7)
Hospital daysc	17.3	1.7	10.1	10.7 (8.4, 13.6)
Prescription costsc ($CAD)	3352.2	580.1	5.8	6.5 (5.2, 8.0)
# of social assistance payments	14.2	4.5	3.1	3.1 (2.7, 3.7)
Social assistance payments ($CAD)	11261.4	3940.4	3.2	3.4 (2.8, 4.1)

MSP Medical services plan

aRate was calculated based on time at risk (exposure time-custody day). Unadjusted Rate Ratio was calculated from the rate for HF Custody by dividing the rate of the non-HF Custody

bNegative binomial regression analysis was conducted to obtain Adjusted Rate Ratio after controlling the effects of time at risk and socio-demographics (age, gender ethnicity and education level). Confidence Intervals were estimated using Robust Standard Errors

cVariables used to determine custody High Frequency user groups

dCalculation was based on exposure time, not by time at risk

Full article at:   http://goo.gl/5qagbH

By:   Somers JM1, Rezansoff SN1, Moniruzzaman A1, Zabarauckas C2.

• 1Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada.
• 2Department of Criminology, Simon Fraser University, Burnaby, BC Canada. 

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