The 130th Annual Meeting of APHA

Abstract #40225

Neil Thakur, Health Services Research and Development/ 124, Department of Veterans Affairs, 810 Vermont Ave. NW, Washington, DC 20420, 203-273-7657, neil.m.thakur@aya.yale.edu, Joseph Morrissey, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, Chapel Hill, NC 27599-7590, John S. Preisser, PhD, Department of Biostatistics, University of North Carolina - Chapel Hill, 3105 F McGavran-Greenberg Hall, Chapel Hill, NC 27599, and Henry Steadman, PhD, Policy Research Associates, Inc, 265 Delaware Avenue, Delmar, NY 12054.

In the past 30 years, there has been mounting concern that jails have become America’s new public mental hospitals, and that this trend has been exacerbated by public sector managed mental health care. To explore this issue, the census of Jail, county mental health, and Medicaid records from King County, (Seattle) Washington were analyzed over a 5.5-year period centered on April 1, 1995. On that date, King County assumed risk for outpatient Medicaid services and entered into a behavioral health carve-out for utilization management with a managed care organization (ASO contract). Deterministic linkage methods were employed to identify unduplicated individuals (N=290,352) who used one or more of the three systems before and after the introduction of managed care. From a population perspective, we found approximately 11-12% of county mental health users (1,600-2,000 county residents) had jail incarcerations each year, representing a steady 5-6% of the population detained in jail each year. These percentages did not change despite increased Medicaid penetration and the adoption of outpatient managed care. However, managed care may affect subgroups of county residents differentially. Persons with serious mental illnesses are thought to be more sensitive to managed care policy changes than the average service user. We will assemble cohorts by diagnosis category and time of entry into the study, and using a longitudinal multivariate approach, measure changes in utilization patterns over time, and map these changes to changes in managed mental health care policy.

Learning Objectives: At the conclusion of the session, participants will be able to

• Identify sub-groups of county mental health users more likely to be detained.
• Identify sub-groups of jail detainees more likely to use county mental health services.
• Identify managed care policies and processes that may be linked with changes in detention patterns for specific sub-groups of county mental health service users.

Keywords: Mental Health Services, Jails and Prisons

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.