Encounters With the Criminal Justice System in Patients With Schizophrenia or Schizoaffective Disorders Treated With Long Acting Therapy at a Community Mental Health Service Facility

Purpose: This study assessed the association between the use of Long-acting injectable (LAI) anti-psychotic drugs and encounters with the criminal justice system (CJS) among patients receiving care for schizophrenia and/or schizoaffective disorders at a community mental health center.  

Methods: A retrospective longitudinal data analysis using clinical and criminal justice data from a community-based mental health service provider and the Clerk of Courts in Ohio for the period of January 31, 2011-February 28, 2018. The index date and an encounter with CJS were defined as: the date of the initiation of a LAI and an arrest for any misdemeanor or felony offenses, respectively. Pre- and post-analyses were used to compare the incidence of encounters before and after the initiation of the index drug [Aripiprazole; Fluphenazine Decanoate; Haloperidol Decanoate; Paliperidone Palmitate once a month (PP1M); or Risperidone].

Results: A total of 975 patients were identified, mean (SD) age was 43.8 (13.5) years and 600 (61.5%) were male. Overall, compared to 1-year period before LAI therapy initiation, patients experienced significantly lower number of CJS encounters 1-year after initiation (Risk Ratio [RR]=0.60; p<0.0001). Patients on PP1M were significantly less likely to have a CJS encounter 6-months (RR= 0.61; p=0.02431) and 1-year (RR= 0.57; p=0.0005) after than before initiation. No statistically significant reduction was observed among patients on other LAIs.

Conclusions: Patients with schizophrenia and/or schizoaffective spectrum disorders initiated on an LAI, and specifically those on PP1M, were less likely to have an encounter with the CJS compared to before the initiation of the drug.