HJAR Jan/Feb 2021

40 JAN / FEB 2021 I  HEALTHCARE JOURNAL OF ARKANSAS POLICY In announcing his proposed budget for the next fiscal year, Governor Asa Hutchin- son said one of his priorities is continuing to fund mental health crisis stabilization units. As these facilities are still a relatively new addition to our state’s healthcare system, manyArkansans may not be aware of what they are and what they seek to do. In recent years, Arkansas has sought to move away from the practice of incarcer- ating people with mental illnesses. By and large, our jails and prisons lack the neces- sary tools to treat acute mental health is- sues, and incarcerating people with mental illnesses has contributed to chronic over- crowding in these facilities and poor health outcomes. Meanwhile, the typical alternative to incarceration, taking people in crisis to hospital emergency departments, has con- tributed to diminished quality of care and soaring healthcare costs. In 2015, the Arkansas General Assembly established the Legislative Criminal Justice Oversight Task Force to study the state’s criminal justice system and recommend COLUMN POLICY reforms. The panel’s recommendations led to the enactment of Act 423 of 2017, which authorized the creation of crisis stabiliza- tion units, or CSUs: 24-hour, 16-bed facili- ties where people experiencing acute mental health issues can, instead of being taken to jails or hospitals, receive stabilizing treat- ment from teams of mental health profes- sionals during stays of up to 72 hours. Arkansas’s first CSU began operating in Sebastian County inMarch 2018, and others followed in Pulaski, Washington and Craig- head counties. In addition to helping people in crisis, goals of the facilities include easing prison overcrowding, reducing recidivism, reducing avoidable and costly utilization of medical services and enhancing public safety. In 2019, the Arkansas Center for Health Improvement (ACHI) used health claims data from the Arkansas Healthcare Trans- parency Initiative’s All-Payer Claims Data- base, as well as jail booking data, to create profiles of jail detainees in Pulaski and Se- bastian counties in terms of their healthcare Crisis Stabilization Units: A Better Place Than Jail for Arkansans with Mental Illnesses utilization, diagnoses and expenditures in the year prior to the opening of the CSU in each county. For both counties, the prevalence among jailed individuals of a serious and persis- tent mental illness (SPMI) as a diagnosis was 31%. Of jailed individuals with three or more bookings in Sebastian County, 31% had a SPMI diagnosis, matching the rate in the overall study population in Sebastian County. The prevalence of SPMI diagnosis among jailed individuals with three or more bookings in Pulaski County was 38%. Emergency department (ED) utilization among jailed individuals in Sebastian and Pulaski counties was similarly comparable, with 44% of jailed individuals in each county having visited the ED at least once during the previous year. In both counties, jailed individuals diagnosed with SPMIs were roughly twice as likely to have visited the ED at least once during the study period as their counterparts without SPMI diagnoses. Of jailed individuals in both counties who were diagnosed with SPMIs and who had