The likelihood that consumers with complex support needs are involved in some form or fashion in the justice system is high. In fact, 2.2% of the U.S. adult population, or seven million, is in prison or jail, on probation, or on parole (see Correctional Population In The United States, 2012), and 16% of that population has a mental illness, or an addictive disorder (35%), or both (45%) (see Addiction & The Criminal Justice System). In addition, there were over 515,000 people last year who ended up in the justice system for abuse or allowing the maltreatment of a child (see Child Maltreatment 2013). All these people are “high cost” to society with health, behavioral health, social system, court system, and corrections system spending.
But, this population is likely to increase in a way that I had not anticipated – with the increase in the number of people with dementias. The headline from our recent news coverage tells the story – see 8.5% Of Patients With Dementia Exhibited Criminal Behavior After Onset. This “new” population of justice-involved consumers includes 7.7% of individuals with Alzheimer’s, 37.4% with frontotemporal dementia, 27% with primary progressive aphasia, and 20% with Huntington disease. I’ve written about the incident of assault in the Alzheimer’s population before – see Another Corrections Interface – Dementia and Alzheimer’s Moves To #6. This new research just reinforces this is not an anomaly – and a large, new group of people that will take up the resources of police, courts, and jails.
While this seems like a minor issue, it takes on a new dimension when you consider the projections for the number of both world, and U.S. citizens. An estimated 44 million people worldwide are currently living with dementia, up 25% from an estimated 35 million in 2010, and this number is expected to rise to 135 million by 2050 (see Worldwide Dementia Estimated At 44 Million People In 2013); and, in the U.S., a third of seniors will develop Alzheimer’s or another dementia at the end of their life. Looking ahead, there will be millions of additional people each year having some contact with the police and with the court system.
I’m not sure that our current system for serving justice-involved consumers with behavioral disorders provides a great model for a solution for this population. According to the National Institutes of Health data, more than 350,000 offenders with mental disorders return to society without receiving “treatment” each year (see Criminals Need Mental Health Care). Of those released, 48% with mental illness are hospitalized in a psychiatric setting within 18 months of their release (see On Mental Illness, Inmates, And Recidivism), and 25% of inmates with a mental health problem had three or more prior incarcerations (see The ROI Of Recidivism Prevention). And whether Medicaid long-term services and supports (LTSS) can be leveraged as a solution to this problem remains to be seen. The current trajectory of disability and related support expenses will challenge state and local budgets (see 47 States To Expand Medicaid LTSS In 2015), health plans (see Where Are The Dual Eligible Demonstration Projects?), and families (see Next Friend Risk).
For more on that challenge, join us at the 2015 Strategy & Innovation Institute on June 16-18, New Orleans for the presentation Serving The Criminal Justice Population: Reentry & Community Mental Health Programs. And, if you are currently working with, or developing new service lines focused on this “new” population, I would love to hear from you (firstname.lastname@example.org) and learn more.