Morrissey Joseph P, Cuddeback Gary S, Cuellar Alison Evans, Steadman Henry J
Department of Health Policy and Administration, School of Public Health and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 27599-7590, USA.
Psychiatr Serv. 2007 Jun;58(6):794-801. doi: 10.1176/ps.2007.58.6.794.
This study sought to determine whether having Medicaid benefits and receiving behavioral health services are associated with a reduction in recidivism for jail detainees with severe mental illness.
A quasi-experimental design with linked administrative data was used. All persons released over a two-year period from jails in King County, Washington (N=5,189), and Pinellas County, Florida (N=2,419), who had severe mental illness were followed for 12 months after jail release. Those who were receiving Medicaid benefits at release and those who were not were compared on three indicators: how many subsequent arrests occurred, how soon the arrest occurred, and how serious the associated offense was. The data were analyzed with negative binomial, Cox proportional hazards models and logistic regression with adjustments for dependent observations.
In both counties, having Medicaid at release was associated with a 16% reduction in the average number of subsequent detentions (p<.001 and p<.01, respectively). After the analysis controlled for demographic and clinical variables, more days on Medicaid were associated with a reduced number of subsequent detentions in King County (p<.001) and more days in the community before subsequent arrest in both counties (p<.01 and p<.05, respectively). No association was found between Medicaid status and the seriousness of the subsequent offense in either county.
Although Medicaid benefits and behavioral health services were associated with fewer rearrests and more time in the community, the observed differences were relatively small. Further research is needed to determine how greater reductions in jail recidivism can be achieved for this target population.
本研究旨在确定享有医疗补助福利并接受行为健康服务是否与患有严重精神疾病的监狱被拘留者再犯率的降低相关。
采用了一种带有关联行政数据的准实验设计。对华盛顿州金县（N = 5189）和佛罗里达州皮内拉斯县（N = 2419）在两年期间从监狱释放的所有患有严重精神疾病的人员在出狱后进行了12个月的跟踪。比较了出狱时享有医疗补助福利的人员和未享有该福利的人员在三个指标上的情况：随后发生了多少次逮捕、逮捕发生的时间有多快以及相关罪行有多严重。使用负二项式、Cox比例风险模型和逻辑回归对数据进行分析，并对相关观测值进行了调整。
在两个县中，出狱时享有医疗补助与随后平均被拘留次数减少16%相关（分别为p <.001和p <.01）。在分析控制了人口统计学和临床变量后，在金县，享有医疗补助的天数越多与随后被拘留次数减少相关（p <.001），在两个县中，在随后被捕前在社区的天数越多（分别为p <.01和p <.05）。在两个县中，均未发现医疗补助状态与随后罪行的严重程度之间存在关联。
虽然医疗补助福利和行为健康服务与再次被捕次数减少以及在社区的时间增加相关，但观察到的差异相对较小。需要进一步研究以确定如何为这一目标人群实现更大程度的监狱再犯率降低。
