MedWire News: US study findings show that individuals with schizophrenia are more likely than the general population to have encounters with the criminal justice system, with most individuals being victims of crime rather than perpetrators.

“Although this study did not assess the personal or societal burden associated with such encounters, it provides – for the first time – an estimate of the direct economic impact of having encounters with criminal justice system… in the context of their total direct healthcare cost,” say Haya Ascher-Svanum (Eli Lilly and Company, Indianapolis, Indiana, USA) and co-authors.

The researchers performed a post-hoc analysis of a prospective 1-year cost-effectiveness study of individuals treated with antipsychotics for schizophrenia and related disorders within 15 states in the USA.

Criminal justice system involvement was evaluated in 609 patients using the Schizophrenia Patients Outcome Research Team (PORT) client survey and the victimization subscale of the Lehman Quality of Life Interview (QOLI). The direct cost of involvement with the criminal justice system was then estimated using previously reported costs.

Of the 609 patients taking part in the study, 278 (46%) had had at least one encounter with the criminal justice system. The most prevalent types of encounters were being a victim of crime (67%), being on parole or probation (26%), and arrest for assault (13%).

Compared with patients who did not have any involvement with the criminal justice system, those who did were significantly younger, with a poorer level of mental health, greater likelihood of substance abuse (alcohol, cannabis, and cocaine), and poorer medication adherence.

In addition, they were more likely to have been hospitalized in the year prior to enrollment, use emergency services, and drop out of the study. The team also found that perpetrators, as opposed to victims of crime, were significantly more likely to be male.

“Although the cause–effect relationship between medication adherence and criminal justice system encounters cannot be delineated from the current study, the findings suggest that involvement may represent yet another, potentially underappreciated consequence of medication non-adherence,” write the authors in the journal BMC Psychiatry.

When the team estimated the cost attributable to these encounters, they found the mean annual per-patient cost of involvement was USD$1429 (€1023/£885). “These encounters may comprise 6% to 11% of the annual per-patient direct total costs. When assessing the costs of schizophrenia, future studies should account for potential criminal justice system involvement whenever possible,” said Ascher-Svanum.

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