In 1992, the Commonwealth of Massachusetts implemented managed care for Medicaid reimbursed mental health and substance abuse services. Analyses of the effects of this intervention indicate that it succeeded in reducing both service use and cost, particularly in the area of inpatient treatment, which declined by 15% in the first year. This proposal seeks to examine a set of potential """"""""secondary effects,"""""""" namely the increased likelihood of arrest and commitment for inpatient forensic evaluation - outcomes that have been shown to be the sequelae of other mental health policy changes that have led to reductions in the use of inpatient care. The process under which this has occurred in the past has been due in part to the perceptions of judges and other actors in the criminal justice system that the inpatient mental health system has become less accessible and less able to meet the needs of mentally ill persons brought to their attention. The research proposed here seeks to determine whether a similar process has been set in motion by managed care with regard to psychiatrically disabled Medicaid clients - the population whose services were most affected by this intervention.
The Specific aims of the project are to address three basic questions: 1) Has the introduction of managed care resulted in increased likelihood of arrest for Medicaid psychiatrically disabled treated adults? 2) Has the introduction of managed care led to increased involvement in the forensic mental health system by this population? and 3) Independent of changes in their level of involvement in these systems, has the type of offenses committed by persons in this population changed? These questions will be addressed by following a cohort of psychiatrically disabled Medicaid beneficiaries for a period of five years (two pre- and three post-managed care). Answering the first two questions will entail modeling, examining trends in types of criminal offenses committed by cohort members over the five year period and a comparison of these patterns with those of the general public. Analyses will draw on data from a 100% sample of Medicaid paid claims data measuring all service use by cohort members over a five year period merged with data on arrest and pretrial forensic evaluations.
| Fisher, William H; Normand, Sharon-Lise T; Dickey, Barbara et al. (2004) Managed mental health care's effects on arrest and forensic commitment. Int J Law Psychiatry 27:65-77 |
| Fisher, William H; Dickey, Barbara; Normand, Sharon-Lise T et al. (2002) Use of a state inpatient forensic system under managed mental health care. Psychiatr Serv 53:447-51 |
