Criminal justice involvement of armed forces veterans in two systems of care.

OBJECTIVE: This study compared criminal justice involvement of veterans before and after receiving services from community-based programs of the Veterans Health Administration (VHA) (N=1,640) or a state Department of Mental Health (DMH) (N= 693). METHODS: Anonymous extracts from VHA, DMH, and statewide criminal charging databases were analyzed by probabilistic population estimation to determine criminal charging rates in the years before and after the year of service receipt in each system of care. RESULTS: Veterans who received DMH services experienced a greater reduction in the rate of criminal charging than veterans who received VHA services (43% and 17% reductions). For veterans with co-occurring mental and substance use disorders, rates were reduced 33% among VHA service recipients, whereas they increased 48% among DMH service recipients. CONCLUSIONS: These differences indicate that the design of veterans' behavioral health service delivery systems would benefit from cross-sector outcome measures that complement clinical measures such as those used nationally by the VHA.

The changing role of the state psychiatric hospital.

State hospitals were once the most prominent components of U.S. public mental health systems. But a major focus of mental health policy over the past fifty years has been to close these facilities. These efforts led to a 95 percent reduction in the country's state hospital population. However, more than 200 state hospitals remain open, serving a declining but challenging patient population. Using national and state-level data, this paper discusses the contemporary public mental hospital, the forces shaping its use, the challenges it faces, and its possible future role in the larger mental health system.

Use of insurance claims data to determine prevalence and confirm a cluster of sarcoidosis cases in Vermont.

OBJECTIVES: In 2006, the Vermont Department of Health was asked to respond to a potential cluster of sarcoidosis cases related to a Vermont office building. Sarcoidosis prevalence has not been formally described for the United States. A range of < 1-40/100,000 is commonly reported; however, we have not identified primary sources supporting this conclusion. Because of the wide prevalence range and lack of a local estimate, confirming existence of a cluster was difficult. METHODS: We ascertained the prevalence of sarcoidosis cases in Vermont by using insurance claims data to determine whether or not a cluster of sarcoidosis cases was related to the office building. We calculated county and state annual prevalence proportions for sarcoidosis for 2004 and 2005 and annual building prevalences for 1992-2006. RESULTS: The pooled sarcoidosis case prevalence for Vermont was 66.1/100,000. The pooled building annual prevalence (1,128/100,000) was statistically different from the county in which the building is located (odds ratio = 15.5, 95% confidence interval 3.0, 50.3). CONCLUSIONS: We reported the first statewide sarcoidosis prevalence in the United States. This prevalence exceeded previous limited and unsubstantiated U.S. reports. Even with Vermont's elevated sarcoidosis prevalence, the presence of a cluster in this building was apparent.

Crime victims and criminal offenders among adults with serious mental illness.

OBJECTIVE: This study compared crime victimization rates with rates of criminal offending among adults with serious mental illness. METHODS: Statistical estimation determined caseload overlap between anonymous extracts from public mental health and criminal justice databases for 13 rural Vermont counties. Participants included 2,610 adults who received community-based services during the study year (July 2005 through June 2006). RESULTS: Among the 2,610 adults 6.6% were identified by police as criminal offenders and 7.1% were identified as crime victims. Compared with the general population, however, their elevated risk of being identified as a victim (2.4) was lower than their elevated risk of being identified as an offender (2.6). These categories are not mutually exclusive. CONCLUSIONS: To better understand involvement in the criminal justice system among adults with serious mental illness, research should consider rates of criminal offending and victimization and compare these with rates for the general population.

Elevated cancer incidence among adults with serious mental illness.

OBJECTIVE: Research is increasingly focusing on the health status of adults with serious mental illness. This study examined databases in Vermont to determine the incidence of cancer in this population. METHODS: Probabilistic statistical methods were used to determine the overlap between the Vermont Cancer Registry and Vermont mental health treatment databases. RESULTS: The incidence of cancer for adults with mental illness was 1.6 percent, more than twice (2.5 times) that of the general population. Among persons with mental illness, elevated risk was greatest for men younger than 50 years (6.6 times the risk of a comparable group in the general population) and lowest for women aged 50 years and older (1.8 times the risk of a comparable group). CONCLUSIONS: These findings raise important questions about the relationship between serious mental illness and cancer. Future research should consider the effect of lifestyle factors, and potential effects of first- and second-generation antipsychotics should be investigated.

Involvement in the criminal justice system among recipients of mental health services after September 11.

OBJECTIVE: This study examined the relative risk of arrest among recipients of mental health services in Washington, D.C., during the 23 months before and the 13 months after the terrorist attacks of September 11, 2001, with the purpose of identifying any change in involvement with the criminal justice system after the attacks. METHODS: Analysis of anonymous data sets provided by the local mental health and police departments provided measures of risk of arrest, relative to that of the general population, for the approximately 5,000 people receiving mental health services each month. Interrupted time-series analysis was used to measure change in relative risk during the 36-month study period. RESULTS: Significant increases were noted in relative risk of arrest after September 11, 2001, among male, nonwhite young-adult recipients of mental health services. Significant change was evident for eight of the 12 age, gender, and racial groups used in this analysis. CONCLUSIONS: Disaster planning and response should include attention to involvement with the criminal justice system among recipients of mental health services. Future research should focus on the nature of the relationship between terrorism and arrest among service recipients.

Impact of multi-agency employment services on employment rates.

Adults with severe and persistent mental illness who received employment services through mental health and/or vocational rehabilitation programs had higher employment rates than individuals who did not receive any employment services. Individuals who received services from both programs had significantly higher employment rates than individuals who received services from only one program. Results indicate that employment services had a greater relative effect on older clients and clients with a schizophrenia diagnosis than on other individuals. This state-wide study relied exclusively on analysis of administrative/operational databases that provide the employment rates for both recipients of vocational services and other clients.

Elevated risk of arrest for Veteran's Administration behavioral health service recipients in four Florida counties.

This paper examines the relative contribution of mental and substance abuse disorders to criminal justice involvement by examining the relative risk of arrest for three groups of adult male recipients of VA behavioral health care services. These groups include men served for both substance abuse and mental health, for only substance abuse, and for only mental health. The relative risk of multiple offences is compared to relative risk of a single offense for each group. Results indicated that relative risk of multiple arrests for the dual diagnosis group is substantially greater than for either of the single diagnosis groups, and greater than the relative risk for recipients of nonbehavioral health services. Relative risk of arrest for recipients of only mental health services is no different than the relative risk for other veterans living in the region under examination.

Mortality of mental health service recipients in Vermont and Oklahoma.

The authors compared statewide mortality rates for people with severe mental illness who were served in public mental health systems of care in Vermont and Oklahoma. In both states, mortality rates for younger service recipients, but not for older recipients, were significantly higher than those for the general population. In interpreting cross-region comparisons, several possible causes of variation, including differences in caseload composition and causes outside the control of the public mental health authority, must be considered.