Mental health costs within the Alberta criminal justice system

We know that there is a relationship between mental illness and crime. We know less about the cost of mental health services as a proportion of all costs within the criminal justice system.  In the absence of such data within the system, we estimated these costs for Alberta, Canada in 2012, using an economic model.  Our model included the costs of diversion (mental health care as a replacement for trial and punishment), psychiatric hospitalization (as directed by a review panel) for persons who are judged not criminally responsible (NCR) or unfit to stand trial (UST), and inpatient and outpatient forensic psychiatry for those who are sentenced.  We used Alberta probabilities to estimate transitions between the nodes of service.

In the Alberta and Canadian criminal justice system mental health services are provided by municipal, provincial and federal levels of government.  The dividing line between provincial and federal incarceration is a two year sentence, with federal prisoners being those who serve terms above these limits.  Federal prison sentences are 2 per cent of all jail and prison sentences.

In our model, some of the key drivers are the number of people who are judged UST and NCR along with the cost per person (about a million dollars per case), the cost of federal psychiatric cases ($126,000 per year), and the percentage of all incarcerated cases that are under federal jurisdiction (specified as being sentenced for over two years). The average sentence in provincial jails is 29 days, which does not leave a lot of time for psychiatric care.

Our results showed that total criminal justice costs in Alberta were $1.18 billion, and of these, $160 million (13.5 per cent) were to provide mental health care.  Costs for NCR and UST accounted for $117 million, which is 73.3 per cent of all mental health costs within the criminal justice system.  Provincial inpatient costs accounted for $21 million and federal inpatient costs accounted for $16 million.

Philip Jacobs
Institute of Health Economics, Edmonton, Alberta, Canada

 

Publication

Mental health services costs within the Alberta criminal justice system.
Jacobs P, Moffatt J, Dewa CS, Nguyen T, Zhang T, Lesage A
Int J Law Psychiatry. 2016 Jul-Aug

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