Rosenheck R A, Banks S, Pandiani J, Hoff R
Department of Veterans Affairs Connecticut-Massachusetts Mental IllnessResearch, Education, and Clinical Center, West Haven, CT 06516-2770, USA.
Psychiatr Serv. 2000 Oct;51(10):1282-7. doi: 10.1176/appi.ps.51.10.1282.
This study examined incarceration rates of users of Department of Veterans Affairs (VA) mental health services in 16 northeastern New York State counties between 1994 and 1997-a time of extensive bed closures in the VA system-to determine whether incarceration rates changed during this period.
Data were obtained for male patients who used inpatient and outpatient VA mental health services between 1994 and 1997 and for men incarcerated in local jails during this period. For comparison, services use and incarceration data were obtained for all men who received inpatient behavioral health care at community general hospitals and state mental hospitals between 1994 and 1996 in the same counties. Probabilistic population estimation, a novel statistical technique, was employed to evaluate the degree of overlap between clinical and incarceration populations without relying on person-specific identifiers.
Of all male users of VA mental health services between 1994 and 1997, a total of 15.7 percent-39.6 percent of those age 18 to 39 years and 9.1 percent of those age 40 years and older-were incarcerated at some time during that period. Dual diagnosis patients had the highest rate of incarceration (25 percent), followed by patients with substance abuse problems only (21 percent) and those with mental health problems only (11 percent). The rate of incarceration among male patients hospitalized in VA facilities was lower than among men in general hospitals or state hospitals (11.6 percent, 23 percent, and 21.7 percent, respectively), but was not significantly different. No significant increase occurred in the annual rate of incarceration among VA patients from 1994 to 1997 (3.7 percent to 4 percent), despite extensive VA bed closures during these years.
Substantial proportions of mental health system users were incarcerated during the study period, especially younger men and those with both substance use and mental health disorders. Rates of incarceration were similar across health care systems. The closure of a substantial number of VA mental health inpatient beds did not seem to affect the rate of incarceration among VA service users.
本研究调查了1994年至1997年纽约州东北部16个县退伍军人事务部（VA）心理健康服务使用者的监禁率——这是VA系统大量床位关闭的时期——以确定在此期间监禁率是否发生变化。
获取了1994年至1997年期间使用VA住院和门诊心理健康服务的男性患者以及同期被关押在当地监狱的男性的数据。为作比较，还获取了1994年至1996年期间在同一县的社区综合医院和州立精神病医院接受住院行为健康护理的所有男性的服务使用和监禁数据。采用概率性人口估计这一新颖的统计技术来评估临床人群和监禁人群之间的重叠程度，而无需依赖个人特定标识符。
在1994年至1997年期间所有使用VA心理健康服务的男性中，共有15.7%——18至39岁人群中的39.6%以及40岁及以上人群中的9.1%——在该期间的某个时候被监禁。双重诊断患者的监禁率最高（25%），其次是仅有药物滥用问题的患者（21%）和仅有心理健康问题的患者（11%）。在VA设施住院的男性患者的监禁率低于综合医院或州立医院的男性患者（分别为11.6%、23%和21.7%），但差异不显著。尽管这些年VA大量床位关闭，但1994年至1997年期间VA患者的年监禁率没有显著增加（从3.7%到4%）。
在研究期间，相当比例的心理健康系统使用者被监禁，尤其是年轻男性以及同时患有药物使用和心理健康障碍的人。各医疗保健系统的监禁率相似。大量VA心理健康住院床位的关闭似乎并未影响VA服务使用者的监禁率。
