Psychiatr Serv. 2013 Sep 1;64(9):856-62. doi: 10.1176/appi.ps.201200406.
This study examined whether possession of psychotropic medication and receipt of outpatient services reduce the likelihood of posthospitalization arrest among adults with serious mental illness. A secondary aim was to compare service system costs for individuals who were involved with the justice system and those who were not.
Claims data for prescriptions and treatments were used to describe patterns and costs of outpatient services between 2005 and 2012 for 4,056 adult Florida Medicaid enrollees with schizophrenia or bipolar disorder after discharge from an index hospitalization. Multivariable time-series analysis tested the effects of medication and outpatient services on arrest (any, felony, or misdemeanor) in subsequent 30-day periods.
A total of 1,263 participants (31%) were arrested at least once during follow-up. Monthly medication possession and receipt of outpatient services reduced the likelihood of any arrests (misdemeanor or felony) and of misdemeanor arrests. Possession of medications for 90 days after hospital discharge also reduced the likelihood of arrest. Prior justice involvement, minority racial-ethnic status, and male sex increased the risk of arrest, whereas older age decreased it. Criminal justice and behavioral health system costs were significantly higher for the justice-involved group than for the group with no justice involvement.
Routine outpatient treatment, including medication and outpatient services, may reduce the likelihood of arrest among adults with serious mental illness. Medication possession over a 90-day period after hospitalization appears to confer additional protection. Overall, costs were lower for those who were not arrested, even when they used more outpatient services.
本研究旨在探讨精神障碍药物的使用和门诊服务是否会降低患有严重精神疾病的成年人在住院后的逮捕风险。次要目的是比较与司法系统有牵连和无牵连的个体的服务系统成本。
使用处方和治疗数据来描述 2005 年至 2012 年间佛罗里达州医疗补助计划的 4056 名成年精神分裂症或双相情感障碍患者出院后 30 天内药物和门诊服务对逮捕（任何、重罪或轻罪）的影响。多变量时间序列分析测试了药物和门诊服务对随后 30 天内逮捕（轻罪或重罪）和轻罪逮捕的影响。
共有 1263 名参与者（31%）在随访期间至少被捕一次。每月的药物持有量和门诊服务的使用降低了任何逮捕（轻罪或重罪）和轻罪逮捕的可能性。出院后 90 天内服用药物也降低了逮捕的可能性。先前的司法参与、少数族裔地位和男性性别增加了被捕的风险，而年龄较大则降低了被捕的风险。刑事司法和行为健康系统的成本对于有司法牵连的群体显著高于没有司法牵连的群体。
常规门诊治疗，包括药物和门诊服务，可能会降低患有严重精神疾病的成年人被捕的可能性。出院后 90 天内持续服用药物似乎提供了额外的保护。总体而言，对于那些没有被捕的人来说，即使他们使用了更多的门诊服务，成本也更低。
