Yet another reason to expand Medicaid


A friend forwarded me a handout being circulated at the Harris County Criminal Justice Coordinating Council detailing a pair of studies of “Kendra’s Law” out of New York, which provides court-ordered outpatient mental health treatment to a small subset of probationers in the “most desperate need for psychiatric treatment.”

According to the handout, “Taken together, the two reports establish that assisted outpatient treatment (“AOT”) drastically reduces hospitalization, homelessness, arrest, and incarceration among people with severe psychiatric disorders, while increasing adherence to treatment and overall quality of life. The independent evaluation further indicates that the effectiveness of Kendra’s Law is not simply a product of systemic service enhancements, but is in part attributable to the value of AOT court orders in motivating treatment compliance.”


It's constitutional - deal with it

Who knows if these outcomes would be replicable in Texas, but these data – particularly the bit about outcomes sustained beyond the probation period – made me think once again about the proposed Medicaid expansion under the federal Affordable Care Act. And since we’re on the subject, I should reference a recent report referenced at Sentencing Law and Policy titled, The Affordable Care Act: Implications for Public Safety and Corrections Populations. That analysis noted that “About half of all people in jails and prisons have mental health problems and about 65 percent meet medical criteria for alcohol or other drug abuse and addiction,” so clearly Medicaid expansion would impact many people who cycle through the justice system. What’s more, “Pre-release and reentry programs might also be better able to connect people who are leaving jail or prison with community-based intervention services,” which would definitely have implications for folks mandated to receive intensive services under some version of Kendra’s Law. The report concluded that:

The ACA is not a panacea – it will not eradicate the societal factors that contribute to excessive poor health among African Americans and other minorities, nor will it eradicate other biases within the criminal justice system that contribute to disparate rates of incarceration. It does, however, pose an opportunity to level at least one dimension of the playing field – access to treatment for mental illness and addiction – two problems that increase the likelihood of arrest and recidivism. In doing so, it may help reduce racial/ethnic disparities in incarceration.

Mandating mental health services for folks with the most severe psychiatric problems could prevent them from cycling through the criminal justice system, as is depressingly common, and if the NY results are any indication, could also prevent a good deal of crime and substance abuse among those with the most severe mental health needs. And if Texas were to expand Medicaid eligibility in 2014, it would present an opportunity for financing such services that at the moment seem fiscally out of reach.

It would help if we had a Governor who cared about the lack of access to health care that so many Texans deal with, but of course there’s nothing in Rick Perry’s decade-plus record as Governor to indicate that he does. And if he really is running for President again, we should all fear the 2013 legislative session as much as we feared the last one, no matter how the elections go.

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