Crime Victimization of Mental Health Consumers and its Health Consequences

Objectives

To determine the crime victimization experienced by adult consumers of Kalamazoo Community Mental Health and Substance Abuse Services, and the emergency department visits and hospitalizations associated with this victimization.

Method

This was a cross-sectional study of all consumers receiving services from Kalamazoo Community Mental Health and Substance Abuse Services (KCMHSAS) in 2009 (N=5906).  A database was built integrating administrative records from KCMHSAS, county prosecutor’s office, and the two county hospitals for the 2000-2010 period.  Statistical analyses were conducted using Pearson Chi Square and ANOVA to compare KCMHSAS consumer victims with non-consumer victims, and comparing KCMHSAS consumers who were victimized with consumers who were not.

 Results

Consumers were victimized at twice the rate of the general county population:  with an annual crime rate of 3585 per 100,000 persons compared to a crime rate of 1720, a rate ratio of 2.1:1.  Just as in the general population, consumer victims are disproportionately female (62.4% of victims) and disproportionately Black race (Black adults constitute 12.8% of the population, but 30.4% of consumer crime victims).  Consumers’ victimization is more violent and more likely to be committed by multiple perpetrators compared to the general population:  83.5% of consumer incidents are assault-related crimes (as opposed to property crimes) versus 78.2% of non-consumer incidents.  Further, over the 2000-2010 study period, 39.4% of consumers had multiple victimizations compared to 28.7% among the general population.  The excess victimization among consumers was due to additional victimization by intimate partners rather than by stranger, acquaintances or other family.  Despite these markers of higher severity, crimes with consumer victims are significantly less likely to be adjudicates, with only 36.8% of consumer-victim charging requests leading to conviction compared to 45.9% of non-consumers’.

 Consumer victimization is associated with substantial health burden to consumers; with higher emergency department visits, greater psychiatric hospitalizations and more medical hospitalizations.  Compared to consumers who have not been victimized, consumer-victims have three times higher emergency department visits, are twice as likely to have a psychiatric hospitalization the same year as the crime, and are 1.7 times as likely to have a medical hospitalization.  Medical hospitalizations were more likely to be for poisoning, substance abuse and injury than their non-victimized consumer peers.

Conclusion

Crime victimization of consumers is higher and more severe than non-consumers, yet results in fewer convictions.  Victimization is associated with substantial health burden, with increased emergency department visits, greater psychiatric hospitalizations, and more medical hospitalizations.