On May 26, the U.S. Department of Justice’s (DOJ) National Drug Intelligence Center (NDIC) released this report, estimating that illegal drug use had an economic impact of $193 billion in 2007.  The authors examined the economic impact of illegal drug use on crime, health, and productivity, attributing the primary cost of illegal drug use to lost productivity, at $120.3 billion.  The authors determined that crime and health costs of illegal drug use totaled $61.4 billion and $11.4 billion, respectively.  NDIC also employed an alternate model, under which lost productivity due to incarceration and homicide were treated as crime costs.  Under that model, crime costs totaled $113.3 billion and productivity costs were estimated at $68.4 billion, though the overall total was unchanged.

From the report:

The National Drug Intelligence Center (NDIC) prepares an annual National Drug Threat Assessment (NDTA) that provides federal policymakers and senior officials with a comprehensive appraisal of the danger that trafficking and use of illicit drugs pose to the security of our nation. To expand the scope of its NDTA, and to provide the Office of National Drug Control Policy (ONDCP) and other federal officials with a broad and deep understanding of the full burden that illicit drug use places on our country, NDIC has prepared this assessment— The Economic Impact of Illicit Drug Use on American Society. The assessment is conducted within a Cost of Illness (COI) framework that has guided work of this kind for several decades. As such, it monetizes the consequences of illicit drug use, thereby allowing its impact to be gauged relative to other social problems.

Full Report: The Economic Impact of Illicit Drug Use on American Society (PDF | 4.76 MB)

U.S. Department of Justics. (2011). The economic impact of illicit drug use on American society.

Many inmates are released from prison without health insurance, leaving those with serious mental illnesses without services that could prevent relapse and a return to institutionalization. This article reviews a program piloted in three prisons in Oklahoma that assists inmates in enrolling in Medicaid upon release, finding that additional support and coordination can result in higher enrollment.

Wenzlow, A., et. al. (2011). Effects of a discharge planning program on Medicaid coverage of state prisoners with serious mental illness. Psychiatric Services, 62:73- 78. doi:10.1176/appi.ps.62.1.73. http://psychservices.psychiatryonline.org/cgi/content/abstract/62/1/73 

Authors: Audra T. Wenzlow, Henry T. Ireys, Bob Mann, Carol Irvin, and Judith L. Teich

On August 24, the North Carolina Office of the State Auditor released an audit of the North Carolina Department of Correction’s (DOC) inmate health care spending.  The audit found that the DOC could save $11.5 million annually by requiring hospitals to bill Medicaid for certain health expenses incurred by eligible inmates.  The federal government does not typically pay for inmate health care; however, Medicaid does cover treatment for eligible inmates in private or county-run hospitals.  DOC officials say they are working with North Carolina Department of Health (DOH) officials to determine inmates’ Medicaid eligibility.  In addition, DOC officials report that they plan to review all inmate hospital admissions for potential Medicaid reimbursement beginning in September. According to the audit, the DOC spent $159.8 million on inmate health care in 2008 and 2009.

From the report:

State of North Carolina Department of Corrections. (2010). Performance Audit: Inmate Medicaid Eligibility, August 2010. Wood, B.A.

On May 4, the National Association of Psychiatric Health Systems (NAPHS) released its annual survey for 2009.  The survey contains trend analysis that examines year-to-year changes in hospitals and residential treatment centers over a two year period, and national averages with data arranged to allow for comparison by occupancy size.  The survey found an increase for demand in 2009 over 2008, including a 3.5 percent increase in inpatient hospital admissions and 1.5 percent increase in residential treatment center admissions.  The survey also examines the payment for care, and found Medicaid, Medicare, private insurance, state governments and other sources such as juvenile justice systems to be the payment sources for behavioral health care.

From the survey:

The 2009 NAPHS Annual Survey provides two distinct views of behavioral healthcare delivery. One chapter provides a trend analysis that looks at changes from year to year in hospitals and residential treatment centers reporting over a two-year period. Another chapter provides national averages to give a snapshot of members’ experiences in the reporting year. This chapter also presents selected data by set-up-and-staffed bed categories to help organizations compare their own experiences to those of facilities of a similar size.

News release: New NAPHS Annual Survey Tracks Behavioral Treatment Trends (PDF | 267.85 KB)  

Table of Contents: New NAPHS Annual Survey Tracks Behavioral Treatment Trends Table of Contents (PDF | 115.92 KB)

To order the survey: Order Form (PDF | 100.77 KB)

National Association of Psychiatric Health Systems. (2010). 2009 Annual NAPHS Survey.

On May 18, California State Auditor Elaine Howle released an audit which found that nearly one-quarter of the $2.1 billion California spent on prisoner health care between 2007 and 2008 went to specialty care services.  The report found that 59,000 of the state’s 170,000 inmates received specialty care and that the cost for specialty care for inmates over age 60 averaged $42,000 annually.  The audit also noted that the health care costs for inmates incarcerated under the three-strike rule, under which three convictions for serious or violent felonies result in a mandatory sentence of 25 years to life, were 13 percent higher than costs for inmates not incarcerated under the rule.  In related news, the California Senate Appropriations Committee approved legislation (SB 1399) May 17 to allow incapacitated inmates that do not pose a threat to others to receive medical parole and on May 20 the California Assembly approved legislation (AB 1817) establishing a process for the state to determine the necessity of certain health procedures and treatments in prisons.  That bill now goes before the Senate.  Lawmakers intend both measures to control prison health care costs.

From the report:

As of April 2009, 25 percent of the inmate population was incarcerated under the three strikes law, which requires longer sentences for individuals who are convicted of any felony and have been convicted previously of crimes defined in state law as serious or violent felonies, also known as strikes. As discussed in our prior report, we estimated that on average, these individuals’ sentences are nine years longer because of the requirements of the three strikes law. In further analyzing the nature of the crimes for which striker inmates are incarcerated, we found that the current conviction for which many are imprisoned is not a strike. However, the longer sentences that striker inmates are receiving are based on their previous strikes. We also found that significant portions of the striker inmate population were convicted of committing multiple serious or violent offenses on the same day, and that some committed one or more serious or violent offenses as a juvenile.

Full report:  California Inmates Sentenced under the Three Strikes Law and a Small Number of Inmates Receiving Specialty Health Care Represent Significant Costs (PDF | 2.19 KB)

California State Auditor. (2010). California Department of Corrections and Rehabilitation: Inmates sentenced under the three strikes law and a small number of inmates receiving specialty health care represent significant costs.

In a speech given to the Princeton University Policy Research Institute on March 5, Nancy G. La Vigne, the Director of the Urban Institute's Justice Policy Center, discussed research that shows rehabilitative reentry programs show promise for people leaving corrections.

From the report:

While our findings on program effectiveness may be mixed, our research at the Urban Institute suggests that, programs aside, exposure to specific reentry practices is associated with better outcomes for exiting prisoners. Our landmark study, Returning Home: Understanding the Challenges of Prisoner Reentry, interviewed soon-to-be released prisoners in four states, following them in the community for up to a year. That research gleaned the following insights:

• Education, specifically obtaining one's GED behind bars, is associated with higher rates of employment after release.
• Employment matters in preventing recidivism, but what makes the biggest difference is the wages one earns; released prisoners who earn $10?12 an hour are twice as likely to remain crime free than their employed counterparts earning minimum wage.
• Drug treatment behind bars is associated with lower rates of relapse in the community.
• Family support can make a tremendous difference in reentry outcomes. Those with strong financial and emotional support from family members are less likely to relapse and return to prison. (Nearly all participants interviewed said they had at least one supportive family member in their lives).

These findings and others like them suggest that the last thing correctional agencies should do is to cut educational, employment, substance abuse treatment, and family reunification programs. To the contrary, in these tough economic times, agencies should consider increasing them in the interests of using reentry initiatives as a means of reducing the correctional population.

Full report: http://www.urban.org/publications/901332.html 

Urban Institute. (2010). Can reentry programs be both effective and cost beneficial? Speech to Princeton University Policy Research Institute. La Vigne, N.G.