Many people with mental health problems end up in prison or jail when access to community-based treatment could have helped avoid incarceration. New research shows how that approach wastes money.

By Stephanie Soucheray

Since the Mental Health Care Reform Act of 2001, North Carolina has struggled with having enough housing and community-based services for those living with mental illness.

This year’s legislative session was once again peppered with discussions about how North Carolina treats its mentally ill citizens. Lawmakers floated a proposal to build a fourth state psychiatric hospital, the Senate budget proposes to cut the state’s three residential alcohol and substance-abuse treatment centers (ADATCs) and both the House and Senate have proposed a statewide telepsychiatry program that would allow people to get crisis services in their home communities.

This and other activities only demonstrate how North Carolina remains in a state of transition when it comes to services for people with mental health disabilities.

Now new research from NC State shows outpatient treatment of mental illness significantly reduces arrest rates for people with mental health problems – and also saves taxpayers money.

Desmarais conducted the study as a collaboration between NC State, RTI International and the University of South Florida. The results of the study, “Effects of Outpatient Treatment on Risk of Arrest of Adults With Serious Mental Illness and Associated Costs,” were published online May 15 in the journal Psychiatric Services.

“There’s always this discussion between spending on mental health versus safety,” said Sarah Desmarais, an assistant professor of psychology at NC State.

“This study shows that it’s more cost efficient to give treatment instead of [relying on] criminal justice,” she said.

People with severe and persistent mental illnesses are over-represented in the criminal justice system throughout the United States. A 2006 U.S. Department of Justice study found about half of state and federal prisoners had mental health problems; that number jumped to about two-thirds in local jails.

Desmarais and colleagues analyzed post-hospitalization arrests between 2005 and 2012 for 4,056 adult Florida Medicaid enrollees with bipolar disorder or schizophrenia. The researchers used a multivariable analysis to compare arrest rates between those who received outpatient care and medication treatment and those who did not.

Thirty percent of those followed were arrested during the study follow-up, but those who received medication and outpatient care were less likely to be arrested.

“Medication and routine outpatient services make a huge difference,” said Desmarais.

She said she and her colleagues knew that treatment is very expensive, and that routine care through Medicaid is also expensive, so they compared the costs of giving medication and outpatient services to the mentally ill and the cost of processing them through the criminal justice system.

Those who were arrested, and received less mental health treatment, cost the government $95,000 during the study period. Those not arrested received more treatment and cost the government approximately $68,000 during the study period.

“The results just confirmed to us that treating the mentally ill is less expensive,” said Desmarais. “And routine outpatient care seems to have a preventative effect against incarceration at costs of about $10 per day.”

She said she has not had any contacts from lawmakers, but she has heard from many advocates in the mental health field who are thrilled with her study’s results.

“We’re undergoing a lot of change right now in the state, and the question is how do we maintain continuous care while all this change is going on?” said Desmarais.

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