Impact of dual diagnosis on healthcare and criminal justice costs after release from Queensland prisons: a prospective cohort study
K. J. Snow A , D. Petrie B , J. T. Young C D E , D. B. Preen D , E. Heffernan F and S. A. Kinner C G H I J *A Centre for International Child Health, Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.
B Centre for Health Economics, Monash Business School, Monash University, Melbourne, Vic., Australia.
C Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Vic. 3053, Australia.
D School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.
E National Drug Research Institute, Curtin University, Perth, WA, Australia.
F Queensland Forensic Mental Health Service, Queensland Health, Brisbane, Qld, Australia.
G Centre for Adolescent Health, Murdoch Children’s Research Institute, Carlton, Vic., Australia.
H Griffith Criminology Institute, Griffith University, Mount Gravatt, Qld, Australia.
I Mater Research Institute-UQ, School of Medicine, University of Queensland, Brisbane, Qld, Australia.
J School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
Australian Journal of Primary Health 28(3) 264-270 https://doi.org/10.1071/PY21142
Submitted: 30 June 2021 Accepted: 3 February 2022 Published: 6 May 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: People released from prison have poorer health than the general public, with a particularly high prevalence of mental illness and harmful substance use. High-frequency use of hospital-based services is costly, and greater investment in transitional support and primary care services to improve the health of people leaving prison may therefore be cost-effective.
Methods: A prospective cohort study of 1303 men and women released from prisons in Queensland, Australia, between 2008 and 2010, using linked data was performed. We calculated healthcare costs and the cost of re-incarceration. We compared healthcare costs to the general public, and assessed the impact of past mental illness, substance use disorder, and dual diagnosis on both healthcare and criminal justice costs.
Results: Healthcare costs among the cohort were 2.1-fold higher than expected based on costs among the public. Dual diagnosis was associated with 3.5-fold higher healthcare costs (95% CI 2.6–4.6) and 2.8-fold higher re-incarceration costs (95% CI 1.6–5.0), compared with no past diagnosis of either mental illness or substance use disorder.
Conclusions: People released from prison incur high healthcare costs, primarily due to high rates of engagement with emergency health services and hospital admissions. Comorbid mental illness and substance use disorders are associated with high health and criminal justice costs among people recently released from prison.
Keywords: alcohol, harmful substance use, health economics, health equity, mental health, prison health.
References
Abbott P, Lloyd JE, Joshi C, Malera-Bandjalan K, Baldry E, McEntyre E, Sherwood J, Reath J, Indig D, Harris MF (2018) Do programs for Aboriginal and Torres Strait Islander people leaving prison meet their health and social support needs? Australian Journal of Rural Health 26, 6–13.| Do programs for Aboriginal and Torres Strait Islander people leaving prison meet their health and social support needs?Crossref | GoogleScholarGoogle Scholar |
Alan J, Burmas M, Preen D, Pfaff J (2011) Inpatient hospital use in the first year after release from prison: a Western Australian population-based record linkage study. Australian and New Zealand Journal of Public Health 35, 264–269.
| Inpatient hospital use in the first year after release from prison: a Western Australian population-based record linkage study.Crossref | GoogleScholarGoogle Scholar | 21627727PubMed |
Allison S, Bastiampillai T, O’Reilly R, Castle D (2018) Access block to psychiatric inpatient admission: implications for national mental health service planning. The Australian and New Zealand Journal of Psychiatry 52, 1213–1214.
| Access block to psychiatric inpatient admission: implications for national mental health service planning.Crossref | GoogleScholarGoogle Scholar | 30303020PubMed |
Australian Bureau of Statistics (2009) ‘Prisoners in Australia.’ (Australian Bureau of Statistics: Canberra, ACT, Australia) Available at https://www.abs.gov.au/ausstats/abs@.nsf/Previousproducts/EA448BE724851071CA257687001CC668 [Verified 30 June 2021]
Australian Bureau of Statistics (2021) ‘Consumer price index.’ (Australian Bureau of Statistics: Canberra, ACT, Australia) Available at https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/consumer-price-index-australia/mar-2021 [Verified 30 June 2021]
Australian Institute of Health and Welfare (2016) ‘The health of Australia’s prisoners 2015.’ (Australian Institute of Health and Welfare: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/reports/prisoners/health-of-australias-prisoners-2015/contents/table-of-contents [Verified 30 June 2021]
Carroll M, Spittal MJ, Kemp‐casey AR, Lennox NG, Preen DB, Sutherland G, Kinner SA (2017) High rates of general practice attendance by former prisoners: a prospective cohort study. Medical Journal of Australia 207, 75–80.
| High rates of general practice attendance by former prisoners: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar |
de Andrade DF, Spittal MJ, Snow KJ, Taxman FS, Crilly JL, Kinner SA (2019) Emergency health service contact and reincarceration after release from prison: a prospective cohort study. Criminal Behaviour and Mental Health 29, 85–93.
| Emergency health service contact and reincarceration after release from prison: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 30697841PubMed |
Department of Community Safety (2011) ‘Annual report 2010–2011.’ (Queensland Government: Brisbane, Qld, Australia) Available at https://www.ambulance.qld.gov.au/docs/DCS_AR_10-11LR.pdf [Verified 30 June 2021]
Domino ME, Gertner A, Grabert B, Cuddeback GS, Childers T, Morrissey JP (2019) Do timely mental health services reduce re‐incarceration among prison releasees with severe mental illness? Health Services Research 54, 592–602.
| Do timely mental health services reduce re‐incarceration among prison releasees with severe mental illness?Crossref | GoogleScholarGoogle Scholar | 30829406PubMed |
Erlyana E, Fisher DG, Reynolds GL (2014) Emergency room use after being released from incarceration. Health and Justice 2, 1–7.
| Emergency room use after being released from incarceration.Crossref | GoogleScholarGoogle Scholar |
Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R (2016) Mental health of prisoners: prevalence, adverse outcomes, and interventions. The Lancet Psychiatry 3, 871–881.
| Mental health of prisoners: prevalence, adverse outcomes, and interventions.Crossref | GoogleScholarGoogle Scholar | 27426440PubMed |
Fazel S, Yoon IA, Hayes AJ (2017) Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction 112, 1725–1739.
| Substance use disorders in prisoners: an updated systematic review and meta-regression analysis in recently incarcerated men and women.Crossref | GoogleScholarGoogle Scholar | 28543749PubMed |
Galassi A, Mpofu E, Athanasou J (2015) Therapeutic community treatment of an inmate population with substance use disorders: post-release trends in re-arrest, re-incarceration, and drug misuse relapse. International Journal of Environmental Research and Public Health 12, 7059–7072.
| Therapeutic community treatment of an inmate population with substance use disorders: post-release trends in re-arrest, re-incarceration, and drug misuse relapse.Crossref | GoogleScholarGoogle Scholar | 26103591PubMed |
Gisev N, Shanahan M, Weatherburn DJ, Mattick RP, Larney S, Burns L, Degenhardt L (2015) A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence. Addiction 110, 1975–1984.
| A cost-effectiveness analysis of opioid substitution therapy upon prison release in reducing mortality among people with a history of opioid dependence.Crossref | GoogleScholarGoogle Scholar | 26212260PubMed |
Harm Reduction International (2020) ‘The global state of harm reduction 2020.’ (Harm Reduction International: London, UK) Available at https://www.hri.global/global-state-of-harm-reduction-2020 [Verified 30 June 2021]
Kinner SA, Lennox N, Williams GM, Carroll M, Quinn B, Boyle FM, Alati R (2013) Randomised controlled trial of a service brokerage intervention for ex-prisoners in Australia. Contemporary Clinical Trials 36, 198–206.
| Randomised controlled trial of a service brokerage intervention for ex-prisoners in Australia.Crossref | GoogleScholarGoogle Scholar | 23850859PubMed |
Morgan A (2018) How much does prison really cost? Comparing the costs of imprisonment with community corrections. Australian Institute of Criminology Reports: Research Report Series: xii.
Ritter A, Berends L, Chalmers J, Hull P, Lancaster K, Gomez M (2014) ‘New horizons: the review of alcohol and other drug treatment services in Australia.’ (National Drug and Alcohol Research Centre: Sydney, NSW, Australia)
Select Committee on Mental Health (2006) ‘A national approach to mental health – from crisis to community.’ (Commonwealth of Australia: Canberra, ACT, Australia) Available at https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Former_Committees/mentalhealth/report/index [Verified 30 June 2021]
Thomas EG, Spittal MJ, Heffernan EB, Taxman FS, Alati R, Kinner SA (2016) Trajectories of psychological distress after prison release: implications for mental health service need in ex-prisoners. Psychological Medicine 46, 611–621.
| Trajectories of psychological distress after prison release: implications for mental health service need in ex-prisoners.Crossref | GoogleScholarGoogle Scholar | 26549475PubMed |
Vickery KD, Bodurtha P, Winkelman TNA, Hougham C, Owen R, Legler MS, Erickson E, Davis MM (2018) Cross-sector service use among high health care utilizers in Minnesota after medicaid expansion. Health Affairs 37, 62–69.
| Cross-sector service use among high health care utilizers in Minnesota after medicaid expansion.Crossref | GoogleScholarGoogle Scholar | 29309230PubMed |
Wang EA, Hong CS, Shavit S, Sanders R, Kessell E, Kushel MB (2012) Engaging individuals recently released from prison into primary care: a randomized trial. American Journal of Public Health 102, e22–e29.
| Engaging individuals recently released from prison into primary care: a randomized trial.Crossref | GoogleScholarGoogle Scholar | 22813476PubMed |
Young JT, Heffernan E, Borschmann R, Ogloff JRP, Spittal MJ, Kouyoumdjian FG, Preen DB, Butler A, Brophy L, Crilly J (2018) Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study. Lancet Public Health 3, e237–e248.
| Dual diagnosis of mental illness and substance use disorder and injury in adults recently released from prison: a prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 29680329PubMed |
