HJLR Nov/Dec 2018

Healthcare Journal of little rock I  NOV / DEC 2018 45 Joseph W. Thompson, MD, MPH Director, Arkansas Center for Health Improvement Governments Justice Center said the CSU in Fort Smith had treated 325 people from Sebastian, Crawford, Franklin, Logan, Polk, and Scott counties. By that time, 328Arkan- sas law enforcement officers had received crisis intervention training. There is empirical evidence regarding the effectiveness of crisis services in address- ing the needs of individuals with mental ill- ness. One study compared two psychiatric emergency units and showed that the unit with crisis stabilization beds experienced lower rates of hospital admissions. An ob- servational study among veterans showed reduced inpatient psychiatric stays follow- ing the introduction of a crisis stabilization program. However, no assessments of the potential for improved health outcomes and fiscal impact of CSUs through jail diversion and the reduction of avoidable medical uti- lization have been undertaken. Thus, Arkan- sas’ program offers a rich opportunity for study. TheArkansasAll-Payer Claims Database, which contains insurance claims data from public and private payers, emergency room discharge records, and other health infor- mation, can be used in conjunction with criminal justice data to track whether CSU interventions result in reduced recidivism, avoided incarceration costs, and more ap- propriate healthcare utilization. Results from such a study could assist Arkansas policymakers in deciding whether to ex- pand the CSU program to other counties and could help policymakers in other states de- cide whether to make Arkansas’s approach a model for their efforts. I applaud the governor, legislators, county officials, and healthcare providers for pur- suing this innovative approach to a difficult problem. Let’s hope we are nearing the end of the era when incarceration was our soci- ety’s primary default mechanism for dealing with some of our most vulnerable citizens— those with mental illness. n “The CSUs are aimed at easing prison overcrowding, reducing recidivism, providing better care for people with mental illness, reducing avoidable utilization of medical services, and enhancing public safety.”