Office‐based mental healthcare and juvenile arrests

Abstract

Criminal behaviors are common among juveniles with the prevalence of committing criminal activities peaking during adolescence. Among industrialized countries, the United States, the focus of our study, is the leader in terms of the juvenile incarceration rate (Annie E. Casey Foundation, 2013) with over 70,000 juveniles in custody on a given day and an average direct annual cost of $112,000 per juvenile (Annie E. Casey Foundation, 2011; Office of Juvenile Justice and Delinquency Prevention, 2011). 1 In 2019, juveniles accounted for 7.1%, 9.8%, and 11.2% of total, violent, and property arrests in the U.S. (Federal Bureau of Investigation, 2020). 2 For the juvenile, being convicted of a crime and associated penalties impedes education, health, and social development, and later earnings. Further, society loses future productivity, tax revenues, and so forth from the incarceration of juveniles. Collectively, these costs are estimated to be $9.8B-$26.7B per year (Justice Policy Institute, 2014). 3 Mental health disorders (MHDs) are the most costly health condition among juveniles, accounting for $16.7B in 2021 with nearly half of this treatment financed by Medicaid (a public insurance program for the poor in the U.S. [Soni, 2018]). 4 The most common MHDs among juveniles are anxiety, depression, and conduct disorder (Ghandour et al., 2019), with prevalence rates of 6.1%, 10.5%, and 7.5% among 12-17 year olds in 2018. Alarmingly, while these conditions can be mitigated with early diagnosis and treatment (Satcher, 2001), juvenile MHDs are increasing over time (e.g., the juvenile suicide rate has increased each year since 2010 [Ruch et al., 2019]). The age profile of criminal trajectories mirrors development of MHDs closely, as adolescence

Medicaid Expansion and mental health treatment: Evidence from the Affordable Care Act

“…Untreated mental illness can lead to increased risk of morbidity and mortality (Ciechanowski et al., 2000; Druss et al., 2009; Katon, 2003; National Institutes of Mental Health, 2020), and suicidal thoughts or depression can lead to adverse educational, employment, and earnings outcomes (Dupéré et al., 2018; Kalist et al., 2007; Slap et al., 2001; Tekin & Markowitz, 2008). Given the adverse effects of mental illness and recent research suggesting that mental health treatment may help decrease the likelihood of arrests and improve career earnings, it may be imperative to expand access to treatment (Biasi et al., 2021; Bondurant et al., 2018; Deza et al., 2021; Jácome, 2020).…”

Evictions and psychiatric treatment

“…Finally, we note that effects need not be symmetric for increases and decreases in access. To explore this issue, we follow Deza et al (2022a) and allow increases and decreases to have differential effects on eviction rates. In particular, we estimate the following regression: Eviction c,s,t = 𝜋 0 + 𝜋 1 Increase c,s,t−1 + 𝜋 2 Decrease c,s,t−1 + X c,s,t 𝜋 3 + 𝛼 c + 𝛼 s,t + 𝜇 c,s,t .…”

Mental health economics—Social determinants and care‐use

“…Deza et al. (2022) show that access to office‐based mental health care improves the mental health of juveniles and, consequently, reduces juvenile arrests in the US. Office‐based mental health care captures various forms of treatment, including medication, counseling, and crisis management.…”

“…Deza et al. (2022) calculate that these forms of treatment represent 59% of the treatment received by juveniles in the US. The authors show that arrest costs are reduced by 2.3%–2.6% for every 10 additional mental health physician and non‐physician offices and that non‐physicians drive this effect.…”

“…Given that mental health care examined by Deza et al. (2022) is not focused on the juveniles most likely to come into conflict with law enforcement and there is suggestive evidence that non‐physicians are more effective than physicians, future research should explore what a targeted intervention should look like and how the target population can be identified because the evidence seems to suggest it would be highly cost‐effective.…”