Services Effectiveness Research Program (SERP)

Duke University School of Medicine
Department of Psychiatry and Behavioral Sciences

Current and Recent Projects

Title: Evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program

Sponsor: Eli Lilly and Company

Principal Investigator(s): Jeffrey Swanson, PhD

SERP Investigators & Collaborators: Marvin Swartz, MD; Allison R. Gilbert, PhD

Project Description: Growing research demonstrates that a substantial proportion of people with severe mental illnesses come into contact with the criminal justice system at some point in the course of their illness. Annually, approximately 1.1 million persons with severe mental illness enter US jails ( National GAINS Center , 2006). Many of these individuals continue on to prison and then parole, or to probation, and some cycle repeatedly through the criminal justice system. The largest urban jails encounter more persons with severe mental illness than any hospital nationwide, and are aptly referred to as de facto mental health institutions. The overrepresentation of persons with severe mental illness in criminal justice settings, and the associated challenges that follow (e.g., providing access to treatment, handling behavioral health problems for incarcerated individuals, reducing repeated cycling through the system), constitutes a large and costly public health problem. Yet, surprisingly, there are no good estimates of the cost of treatment of severely mentally ill persons who come into contact with the criminal justice system. Cost estimates from correctional institutions greatly underestimate the size and needs of justice-involved individuals with mental health services needs. Of the approximately 7 million persons under correctional supervision in the US , about 5 million are not incarcerated but reside in the community under probation or parole supervision. Comprehensive and specific information is lacking about the costs of both mental health and criminal justice services provided to justice-involved persons with severe mental illness across service-system settings. The proposed study will provide such information by gathering and jointly analyzing data from public mental health, correctional, and health services entitlement programs in Connecticut .

The evaluation will be conducted in collaboration with the Connecticut Department of Mental Health and Addiction Services (DMHAS) and the Connecticut Department of Correction (DOC). The study will examine the mental health services and criminal justice records of 200 DMHAS clients currently involved with the criminal justice or forensic mental systems, compared to 200 demographically and diagnostically matched DMHAS clients with no CJ/forensic involvement and not arrested within the past 2 years.

The study will examine for the CJ-involved SMI individuals: (1) time spent incarcerated in jail or prison, or supervised on probation or parole; (2) the utilization and cost of both mental health and justice services provided to these individuals directly in conjunction with their criminal justice involvement; and (3) utilization and cost of other mental health services provided to these individuals during the study period, i.e., services not associated with criminal justice involvement. Total service costs, and proportion of costs by payer (DMHAS vs. DOC), will be compared between the CJ-involved and noninvolved cohorts.