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APHA Scientific Session and Event Listing

Recorded presentation

Jangho Yoon, MSPH¹, Marisa Domino, PhD¹, Joseph Morrissey, PhD², Edward Norton, PhD¹, and Gary Cuddeback, PhD, MSW². (1) Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB #7411, McGavran-Greenberg Building, Chapel Hill, NC 27599-7411, 919-757-2886, jang@unc.edu, (2) Program on Mental Health Services Research, Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 Martin Luther King Jr. Blvd., CB#7590, Chapel Hill, NC 27599-7590

Purpose: There has been a substantial decrease in the number of psychiatric beds over the past several decades; however, the extent to which the reduction in the number of psychiatric beds and the probability of incarceration in our local jails for persons with severe mental illness has yet to be examined. This study examines the extent to which a decrease in psychiatric beds is associated with the likelihood that persons with severe mental illness are detained in jail.

Study Design: Using a sample from three service systems in King County, Washington – jail, the public mental health system, and Medicaid – from 1993 to 1998, 2.6 million individual-month observations on 41,465 adults aged 18 - 64 over 66 months were created. The sample was separated into four groups: individuals with co-occurring severe mental illness and substance abuse; individuals with severe mental illness; individuals with serious but not severe mental illness; and individuals without mental illness.

Results: The number of psychiatric beds in King County decreased by 236 (15 percent) over the study period and, on average, the decrease of 236 beds was associated with 0.25 percentage-point increase in the probability that these persons were incarcerated each month. No significant effects were found for the other three groups.

Conclusions: There appears to be a relationship between a decrease in psychiatric beds and jail use by individuals with co-occurring severe mental illness and substance abuse disorders. Policymakers should be aware that reductions in the number of psychiatric beds could have unintended consequences.

Learning Objectives:

• At the conclusion of the session, the participant will be able to discuss the extent to which a decrease in psychiatric beds is associated with the likelihood that persons with severe mental illness are detained in jail.

Keywords: Mental Health Services, Mental Illness

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation