Criminal Justice System as the de facto Mental Health Services System in DeKalb County, Georgia (2012): A Descriptive Cost Analysis

Background: DeKalb County, Georgia has a large number of repeat offenders who are mentally ill and established a dedicated Mental Health Division in the Public Defender’s Office (PDO) in 2008 to meet the need.

Methods: Interviews were conducted with personnel at the PDO to describe the role of the specialized Division. In addition, data were gathered on the incarceration costs for mentally ill misdemeanor PDO clients arrested in 2012 and compared with estimates for non-mentally ill offenders. The responsibilities and county budget of the public mental health services provider, the Community Service Board (CSB) were also investigated. Expenditures of the agencies were compared and their interactions explored.      

Findings: SPMI misdemeanor offenders arrested in 2012 spent an average of 64 days in jail at a housing cost of $18,921. Non-mentally ill misdemeanor offenders spent an average of 7-10 days in jail at a cost of $577. The county spent $15 million on mental health services in the jail as compared to $1.6 million through the CSB.

Implications: SPMI misdemeanor offenders are being housed in jail at a significant cost. Jail mental health services focus on stabilization, with little return on investment as rates of recidivism are high.  Minimal coordination exists between the Jail, CSB and PDO, and SPMI offenders can lose eligibility for CSB services while incarcerated. Development of targeted policies to align agency efforts is warranted and likely to both decrease costs to the criminal justice system through reduced recidivism and result in better health outcomes for this population.

---

Learning Areas:

Biostatistics, economics
Provision of health care to the public
Public health or related public policy
Public health or related research

Learning Objectives:
Describe how the criminal justice system has become the de facto mental health services system for low-income mentally ill misdemeanor offenders in DeKalb County, Georgia. Compare county funding for mental health services in each system and evaluate expenditures for this population.

Keyword(s): Mental Health System, Criminal Justice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal on this study focusing on the warehousing of mentally ill offenders in the Jail from both an economic and public health perspective. Among my interests has been the evaluation of policies in order to inform more efficient and equitable strategies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4218.0: Health policies leading to improvements in health: criminal justice population