Costs of Criminal Justice Involvement and Service Utilization among Persons with Severe Mental Illness in Connecticut

The intersection of crime and mental illness in the U.S. poses formidable challenges for both criminal justice (CJ) and behavioral health service systems, especially in an era of extreme strain on state resources to invest in progressive programs. Over 2.3 million adults are incarcerated and over 700,000 are released from prison each year. Among them, about 1 in 5 has a diagnosable serious psychiatric disorder and often coincident substance abuse disorders. Comprehensive estimates of the cost of CJ involvement among people with severe mental illness (SMI) are needed to inform public policy, but have been lacking. Our study provides new information on the prevalence, patterns, correlates, and state costs of CJ involvement among 25,133 people with SMI who were served by the public behavioral health services system in Connecticut during 2006-2007. Administrative records from public mental health, law enforcement, criminal justice, and Medicaid agencies were merged to identify patterns of service utilization and associated costs among 6,904 persons with SMI who were involved with the CJ system, and 18,229 who were not involved. Unit costs for all relevant CJ and behavioral health categories were calculated and combined with utilization data to provide a complete picture of the public costs, by payer, for those with and without CJ involvement. A more detailed analysis of utilization and costs is provided by a manual review of treatment records for a stratified random sample of 200 CJ-involved and 200 not CJ-involved individuals with SMI in the public behavioral healthcare system. Policy implications are discussed.