Bed closures and incarceration rates among users of veterans affairs mental health services

Objective: This study examined incarceration rates of users of Department o f Veterans Affairs (VA) mental health services in 16 northeastern New York State counties between 1994 and 1997-a time of extensive bed closures in th e VA system-to determine whether incarceration rates changed during this pe riod. Methods: Data were obtained for male patients who used inpatient and outpatient VA mental health services between 1994 and 1997 and for men inca rcerated in local jails during this period. For comparison, services use an d incarceration data were obtained fur all men who received inpatient behav ioral health care at community general hospitals and state mental hospitals between 1994 and 1996 in the same counties. Probabilistic population estim ation, a novel statistical technique, was employed to evaluate the degree o f overlap between clinical and incarceration populations without relying on person-specific identifiers. Results: Of all male users of VA mental healt h services between 1994 and 1997, a total of 15.7 percent-39.6 percent of t hose age 18 to 39 years and 9.1 percent of those age 40 years and older-wer e incarcerated at some time during that period. Dual diagnosis patients had the highest rate of incarceration (25 percent), followed by patients with substance abuse problems only (21 percent) and those with mental health pro blems only (11 percent), The rate of incarceration among male patients hosp italized in VA facilities was lower than among men in general hospitals or state hospitals (11.6 percent, 23 percent, and 21.7 percent, respectively), but was not significantly different. No significant increase occurred in t he annual rate of incarceration among VA patients from 1994 to 1977 (3.7 pe rcent to 4 percent), despite extensive VA bed closures during these years, Conclusions: Substantial proportions of mental health system users were inc arcerated during the study period, especially younger men and those with bo th substance use and mental health disorders. Rates of Incarceration were s imilar across health care systems. Tbe closure of a substantial number of V A mental health inpatient beds did not seem to affect the rate of incarcera tion among VA service users.