Ramezani Niloofar, Hailemariam Maji, Breno Alex J, Mackey Benjamin J, Cuellar Alison Evans, Johnson Jennifer E, Taxman Faye S
Department of Biostatistics, Virginia Commonwealth University, 830 East Main Street, PO Box 980032, Richmond, VA, 23298-0032, USA.
Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA.
Health Justice. 2023 Jul 4;11(1):27. doi: 10.1186/s40352-023-00226-9.
The national Stepping Up Initiative has attracted over 500 counties interested in reducing the use of jail for individuals with mental health disorders. This paper identifies socioeconomic, criminal legal, and health care factors that predict the likelihood of counties joining Stepping Up.
After performing variable selection, logistic regression models were performed on 3,141 U.S. counties. Counties designated as medically underserved and/or mental health staffing shortage areas were less likely to participate in this initiative. Logistic regression models showed that larger counties (populations over 250,000) with better health care infrastructure, more mental health providers per capita, higher percent of Medicaid funded drug treatment services, and at least one medical school, were more likely to join Stepping Up. These counties had lower per capita jail populations, higher concentration of police resources, and higher pretrial incarceration rate.
County-level health care delivery factors are major contributors to a county's likelihood, or willingness, of engaging in Stepping Up reform efforts to reduce jail population with mental health disorders issues. Therefore, improving availability and accessibility of medical and behavioral health care in different communities, may facilitate efforts to address the unnecessary incarceration of individuals with mental health disorders.
全国“加速行动倡议”已吸引了500多个有意减少对患有精神疾病者使用监狱的县。本文确定了预测各县加入“加速行动”可能性的社会经济、刑事法律和医疗保健因素。
在进行变量选择后，对3141个美国县进行了逻辑回归模型分析。被指定为医疗服务不足和/或精神卫生人员短缺地区的县参与该倡议的可能性较小。逻辑回归模型显示，拥有更好医疗基础设施、人均精神卫生服务提供者更多、医疗补助资助的药物治疗服务比例更高以及至少有一所医学院的较大县（人口超过25万）更有可能加入“加速行动”。这些县的人均监狱人口较少、警察资源集中度较高且审前监禁率较高。
县级医疗服务提供因素是一个县参与“加速行动”改革努力以减少患有精神疾病者监狱人口可能性或意愿的主要因素。因此，提高不同社区医疗和行为健康服务的可及性和可获得性，可能有助于解决对患有精神疾病者不必要监禁的问题。
