Expenditure trajectories for individuals with serious mental illness and criminal justice involvement

Objective: This study examines criminal justice, health, and social service expenditures and their trajectories over 4 years for individuals with serious mental illness (SMI) who had contact with the criminal justice system, and determines whether individual characteristics are related to expenditure patterns.

Methods We used multiple administrative data sets to identify adults with SMI who were arrested in a large urban county in Florida in FY 03-04 and to document their criminal justice, health, and human service expenditures. Latent class growth analysis was used to categorize individuals into subgroups based on their trajectory of expenditures over the 4 years. Multinomial logistic regressions were estimated to determine the relationship between individual characteristics and group membership.

Results: Mean total expenditures were $7,320 per person year for the 3,769 people in the sample. The latent growth analysis identified three groups: participants with consistently low expenditures across the 4 years, those who incurred steadily increasing expenditures, and those with a downward expenditure trend. Involuntary commitments and mental health events (inpatient, outpatient and emergency room events) were associated with greater likelihood of being in the increasing-cost group or the decreasing-cost group relative to the consistently low-cost group. Younger individuals (ages 21-39) were more likely to be in the steady or decreasing-expenditure group, and those diagnosed with depression were more likely to be in the steady or increasing-expenditure group.

Conclusions: The relationship between individual characteristics and group placement suggests that interventions may be designed to target those at risk for increasing costs to the public sector.