Comparing For-Profit and Nonprofit Mental Health Services in County Jails
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f Behavioral Health Services & Research, 2020. 1–9. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09733-1
For-Profit vs. Nonprofit Mental Health Services in County Jails
COMARTIN ET AL.
have risen over the past two decades, the outsourcing of physical and mental health care to forprofit providers is a growing trend that is generally argued as a cost-savings opportunity.18, 19 Similar to research from other health care settings,13–17 findings from prison studies suggest that for-profit providers offer fewer services. For example, a national study of mental health services found that for-profit prisons have lower numbers of psychological/psychiatric counseling programs than nonprofit counterparts.20 Proponents for privatizing health and mental health services argue that, in addition to cost savings, for-profit providers offer higher quality services.18 Other scholars argue that the focus on “number of services” provided by for-profit or nonprofit health providers in correctional settings is short sighted, as it ignores the quality of services rendered.21 Of particular importance in considering the relevance of provider type, it is important to note that jail processes and populations differ from state and federal prisons. Jails experience rapid turnover in their population and characteristically jail detainees have briefer stays,22 as well as a higher per diem cost that is passed on through local taxes.23 To date, data on variation in service delivery and outcomes primarily focuses on general health within prisons, amidst evidence that privatization of mental health care in jails is expanding.24 A report from the state of Virginia found that 40% of mental health services provided in their jails were delivered by for-profit providers, up from 14% in 2009.25 In New York, 84% of jails utilized a for-profit health care provider for at least a portion of the medical services, including mental health services.26 As correctional facilities increasingly adhere to APA guidelines, as illustrated in the increased use of standardized mental health screens for the identification of individuals with SMI in prisons and jails,27 there remains a discrepancy between those identified and corresponding service provision. In fact, estimates range from 7 to 33% of the identified SMI population ultimately being served, often with long lag times between booking, identification, and service provision.2, 28–33 This is the first study to evaluate mental health service delivery between for-profit and nonprofit providers in a jail setting. Using linked screening and administrative data, as well as observational and interview data from a multi-site evaluation, this analysis assesses the provision of mental health services. Analyses examine differences in the screening and identification of individuals with SMI between jails with nonprofit and for-profit providers, as well as whether there are subsequent differences in referrals or services received.
Methods Study design This study is derived from a multi-site evaluation of jail-based mental
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