Community Reentry of Persons with Severe Mental Illness Released from State Priso

项目概述/摘要刑事司法系统中涉及的精神病患者代表了社区心理健康和残疾研究的新前沿。这一问题的范围确实令人震惊，每年有超过86,000名患有严重精神疾病（SMI）的人从监狱获释，其累犯率很高。被监禁的罪犯失去医疗补助福利被认为是成功重返社区的主要障碍。一些州已经采用了快速恢复医疗补助计划，使符合条件的囚犯在释放前重新获得福利。早期的福利恢复可以避免严重精神障碍罪犯被释放到社区后的药物治疗方案和治疗中断。然而，没有进行严格的研究来确定这些政策的成本效益。该提案回应了NIMH的RFA-MH-09-050，并进行了一项为期三年的研究，通过评估康涅狄格州和华盛顿州的医疗补助恢复政策来解决这些问题，这些政策涉及三种结果-随后的再犯，住院治疗，门诊精神健康和药物滥用服务使用。将实施两个互补的研究设计和分析方法，以解决这些政策的影响（目标1）和成本效益（目标2）。第一个是差异中差异设计，比较重度精神障碍个体和非重度精神障碍个体，以2005年4月1日康涅狄格和2006年1月1日华盛顿的政策采纳日期为中心，每个州的政策采纳日期分别为前三年和后两年。第二个是准实验研究设计，重点是在为期两年的随访期内，使用分层线性建模框架，仅比较接受加速医疗补助恢复的重度精神障碍患者（治疗组）与未接受医疗补助恢复的重度精神障碍患者（对照组）。倾向评分匹配将用于两种设计，以实现所有观察措施组之间的平衡。拟议的研究与RFA-MH-09-050非常一致，因为它为州当局解决了一个重要的精神卫生政策问题，利用了来自两个州的大量行政数据，应用了经济学和统计学领域的一系列分析策略来解决一个重要的州精神卫生政策问题，并响应总统精神健康新自由委员会（2002年）提出的关于涉及司法的严重精神疾病患者的研究呼吁。

DESCRIPTION (provided by applicant): Project Summary/Abstract Mentally ill persons involved in the criminal justice system represent the new frontier for community mental health and disability research. The scope of this problem is truly staggering with upwards of 86,000 persons with severe mental illness (SMI) released from prisons each year with high rates of recidivism. The loss of Medicaid benefits by incarcerated offenders is thought to be a major obstacle to successful community reentry. Several states have adopted expedited Medicaid restoration programs to reconnect eligible prisoners to their benefits prior to release. Early benefit restoration can avoid disruptions in medication regimens and treatments for offenders with SMI when they are released to the community. However, no rigorous research has been conducted to establish the cost-effectiveness of these policies. The proposed responds to with RFA-MH-09-050 from the NIMH with a three-year study that addresses these concerns by undertaking an assessment of Medicaid restoration policies in Connecticut and Washington State for released prisoners who have SMI with regard to three outcomes-subsequent recidivism, hospitalizations, and outpatient mental health and substance abuse service use. Two complementary study designs and analytic approaches will be implemented to address the impact (Aim 1) and cost-effectiveness (Aim 2) of these policies. The first is a difference-in-difference design comparing individuals with SMI and those without SMI centered on a policy adoption date of April 1, 2005 in Connecticut and January 1, 2006 in Washington with three years pre and two years post data in each state. The second is a quasi-experimental study design focused on the post-period only comparing individuals with SMI who received expedited Medicaid restoration (treatment group) vs. those who did not (comparison group) over a two-year follow-up period using a hierarchical linear modeling framework. Propensity score matching will be used with both designs to achieve balance between groups on all observed measures. The proposed study is well-aligned with RFA-MH-09-050 in that it addresses an important mental health policy issue for state authorities, takes advantage of a wealth of administrative data from two states, applies an array of analytical strategies from the fields of economics and statistics to address an important state mental health policy issue, and responds to the call for research about justice-involved persons with severe mental illness as put forth in the President's New Freedom Commission on Mental Health (2002). PUBLIC HEALTH RELEVANCE: All across the US mentally ill offenders are returning to their home communities. Research needs to identify their needs and how they can successfully reintegrated into community life without further criminal justice involvements. This proposal is addressed to this major public health problem.