RESEARCH WEEKLY: Arrests of Individuals with Co-Occurring Substance Use and Mental Health Disorders By Hope Parker (March 15, 2023) Individuals with co-occurring substance use and mental health disorders are 12 times more likely to be arrested compared to those without either disorder, according to new research published last month by The Pew Charitable Trusts. Individuals with co-occurring disorders make up only two percent of the U.S. population, but make up 15 percent of all people arrested, according to the data. Despite this population being at a higher risk of criminal justice involvement, only 10 percent of people with co-occurring disorders reported receiving treatment for both their substance use disorder and mental illness. This statistic highlights a large treatment gap for those who need integrated substance use and mental health services. Methodology Researchers from The Pew Charitable Trusts analyzed data from the National Survey on Drug Use and Health from 2017, 2018 and 2019. The NSDUH is an annual survey conducted by the Substance Abuse and Mental Health Services Administration that measures substance use, mental health and other health-related issues in the United States. In NSDUH, participants are asked about their experiences being arrested and booked within the past year, as well as about any mental health or substance use disorder that was sufficient to meet “Diagnostic and Statistical Manual of Mental Disorders, 4th edition” (DSM-IV) criteria. Individuals who had moderate or severe mental illnesses within the past 12 months were considered to have a mental illness for this analysis, while individuals with mild mental illnesses were classified as not having a behavioral health disorder. Key findings Individuals with co-occurring disorders were 12 times more likely to be arrested than those without a behavioral health disorder and six times more likely to be arrested than those with a mental illness alone. Individuals with a substance use disorder alone made up over one-fourth of arrests, despite making up only five percent of the U.S. population. The authors found that almost half of arrests for adults with co-occurring disorders were for drug-related charges, indicating that substance use specifically puts individuals with mental illness at a higher risk of contact with the criminal justice system. The other listed reasons for arrest of individuals with co-occurring disorders in this report were property offenses (17 percent) and violent offenses (10 percent). Arrests by Substance Use Individuals with co-occurring disorders using methamphetamine were the most likely to be arrested, followed by cocaine, opioids, marijuana and alcohol. Most of those arrested had substance use disorders that involved two or more substances. Two-thirds of those with multiple substance use disorders had an alcohol use disorder. However, only a smaller percentage of those with alcohol use disorder were arrested, likely because alcohol is legal, according to the authors. Treatment Although one in nine adults with a co-occurring disorder were arrested annually, only 10 percent received treatment for both their mental illness and substance use disorder. More than four in 10 individuals with co-occurring disorders received no behavioral health treatment at all in the prior year. Racial Disparities Racial disparities were found in data relating to arrest and treatment. Black individuals with co-occurring disorders were 1.5 times more likely to be arrested than white or Hispanic individuals, according to the data. Additionally, only seven percent of Black and Hispanic individuals received treatment for both substance use and mental health disorders, compared with 11 percent of white individuals. Black and Hispanic individuals with co-occurring disorders were also less likely to receive any kind of treatment (47 percent and 43 percent respectively) compared to white individuals (64 percent). Women with Co-Occurring Disorders This analysis also showed that more than one in five arrests of all women who had been arrested had a co-occurring mental illness and substance use disorder. That makes arrest for a woman with co-occurring disorders approximately 19 times more likely as compared to a woman with no behavioral health disorders. Implications Approximately 60 percent of those with a moderate or serious mental illness who are arrested also have a substance use disorder, indicating a co-occurring substance use disorder is a large factor in the criminal justice involvement of individuals with serious mental illness. The Pew Charitable Trusts suggests that integrated treatment for those with co-occurring disorders may help reduce their contact with the justice system. Some studies indicate that more integrated mental health and substance use treatment availability would likely also have positive effects on wages, employment, housing stability, physical and mental health for those with mental illness. References McIntyre, T., Velázquex. V., Feng, S., & Wertheimer, J. (2023, February). More Than 1 in 9 People With Co-Occurring Mental Illness and Substance Use Disorders Are Arrested Annually. The Pew Charitable Trusts. Hope Parker is a research assistant at Treatment Advocacy Center. 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