Relationship Between Psychiatric Inpatient Beds and Jail Populations in the United States.
Relationship Between Psychiatric Inpatient Beds and Jail Populations in the United States.
复制标题
DOI：
10.1097/pra.0000000000000524
复制
发表时间：
2021-01-21
影响因子：
1.9
通讯作者：
Gao YN
中科院分区：
文献类型：
--
作者：
Gao YN
在过去的50年里，美国刑事司法系统的精神病患者人数急剧增加。减少精神病病床的数量是一个拟议的原因，更多的精神病病床可能是一个解决方案。本研究探讨了当地精神科病床容量，当地监狱囚犯人口和精神科负担在当地综合医院的大的变化之间的关系。这项研究使用了一种核心方法来识别美国医院协会调查和医疗保险服务提供者数据中精神科床位容量的突然变化。数据汇总到医院转诊区域（HRR）年水平，并与1988-2015年全国住院患者出院样本和1985-2014年监狱年度调查相匹配。随后的事件研究分析探讨了突然床变化对监狱囚犯人数的影响。当地精神病床位容量的减少与监狱囚犯平均增加256.2人（95%CI）相关[3.3，509.1]。精神科床位容量的增加与199.3 [-457.4，58.8]名囚犯的减少有关。有限的证据表明，在精神科病床减少后，对综合医院的溢出效应立即显现。当地精神病床位容量的减少似乎与当地监狱人口的随后增加有关。没有明确的证据表明治疗从精神科转到当地综合医院。这些发现支持了这样一种担忧，即减少精神病住院床位容量的后果是由于更多的精神病囚犯而导致监狱人口增加，加剧了美国刑事司法系统内精神病治疗的挑战。
The U.S. criminal justice system has witnessed dramatic increases in its mentally ill population during the past 50 years. Decreasing numbers of psychiatric beds is one proposed cause and more psychiatric beds may be one solution. This study examines the relationships between large changes in the local psychiatric bed capacity, local jail inmate populations and the psychiatric burden at local general hospitals. The study uses a kernel method to identify abrupt changes in psychiatric bed capacity from American Hospital Association Survey and the Medicare Provider of Services data. Data were aggregated to the hospital referral region (HRR)-year level and matched to the National Inpatient Sample of hospital discharges 1988–2015 and the Annual Survey of Jails 1985–2014. Subsequent analysis by event study examines the effect of abrupt bed changes on jail inmate numbers. Decreases in local psychiatric bed capacity were associated with an average increase of 256.2 jail inmates 95% CI [3.3, 509.1]. Increases in psychiatric bed capacity were associated with a decrease of 199.3 [−457.4, 58.8] inmates. There was limited evidence for spillovers to general hospitals immediately following decreases in psychiatric beds. Decreases in local psychiatric bed capacity appear to be associated with subsequent increases in local jail populations. There was no clear evidence that treatment shifts from psychiatric units to local general hospitals. These findings support concerns that a consequence of reducing psychiatric inpatient bed capacity is an increase in the jail population due to more psychiatrically ill inmates, aggravating the challenge of psychiatric treatment delivery within the U.S. criminal justice system.