Article used: https://onlinelibrary.wiley.com/doi/epdf/10.1002/cbm.2286
Heading: Economic evaluations of mental health interventions in criminal justice
Address the Following Questions:
Describe the Data Used
In (Knapp & Wong, 2023) a narrative review is designed around the four point points on criminal justice system: (a) point of contact; (b) post-arrest; (c) incarceration/punishment and (d) post-incarceration. In this research secondary data is used that is available in the form of different research articles and available at different digital repositories like Google scholar, emerald and Wiley, Taylor and Francis and science direct or IEEE. The major purpose of this narrative review is to perform the economic evaluation by comparing the costs with outcomes from different studies conducted by different authors working in the field of criminal justice. .
Justify the Use of Secondary Data:
Secondary data is more reliable in terms of narrative reviews because the research papers that are used in this study are available under good journals that are peer reviewed by different researchers working in the same filed. All the secondary resources that are used in this research as evidences are indexed under good publishing house like Scopus and SCI. These publication houses provide the best research papers that are having high impact factors in the research field (Hox & Boeije, 2005). Despite having so many advantages of using secondary journals in this research there are certain disadvantages of this narrative reviewing such lack of real time analysis and practical experiments, in this research there is not any kind of primary experiment or analysis performed. This kind of research has lack of real time implementation that effects the final conclusion of the research. It is time consuming process to conduct this narrative review because it is quite hard to find out the research journals that are available under good indexing (olive, 2015), more experienced person or researcher is required to filter the good resources from the huge pool of resources available online.
Examine How Secondary Data was utilized:
In this research narrative reviews are used or we can say that evidence based analysis is performed on the basis of secondary research journals available online. Comparative analysis is conducted between the different research studies to evaluate the Mental health by the use of literature review and different research journals are used to compare the costs and outcomes of different intervention related to mental health (Johnson, 2020). Table based comparison is performed on the basis different parameters such as costs, author of the studies, key findings of the journals and type of studies used in the research.
References
1. Hox, J. J., & Boeije, H. R. (2005). Data collection, primary vs. secondary. Encyclopedia of Social Measurement, 593–599. https://doi.org/10.1016/b0-12-369398-5/00041-4
2. olive. (2015). Primary and secondary data analysis. Advanced Qualitative Research: A Guide to Using Theory, 129–146. https://doi.org/10.4135/9781529622782.n7
3. Johnson, (2020) Process of qualitative document analysis. (2020). Qualitative Media Analysis, 38–74. https://doi.org/10.4135/9781452270043.n3
4. Knapp, M., & Wong, G. (2023). Economic evaluations of mental health interventions in criminal justice. Criminal Behaviour and Mental Health, 33(2), 139–148. https://doi.org/10.1002/cbm.2286
Criminal Behav Ment
Health - 2023 - Knapp - Economic evaluations of mental health interventions in criminal justice.pdf
Crim Behav Ment Health. 2023;33:139–148. wileyonlinelibrary.com/journal/cbm 139
1London School of Economics and Political
Science, London, UK
2The University of Hong Kong, Hong Kong,
Hong Kong
Correspondence
Martin Knapp.
Email:
[email protected]Abstract
Background: Mental health interventions targeting crime
perpetrators are available. An overview of the current
scenario of their economic benefits will help policy decisions.
Aim: To provide an update on economic evidence for
mental health interventions in criminal justice, and to iden-
tify challenges and responses in using economic evidence to
inform policy.
Method: Narrative review with an analysis frame that
organises evidence around four points on the criminal
justice system pathway: (a) point of contact; (b) post-arrest;
(c) incarceration/punishment and (d) post-incarceration.
Results: There is a paucity of high-quality economic
evidence, especially from cost-benefit analyses. However,
there is some evidence of cost-effectiveness in support
of interventions at the point of incarceration, such as
cognitive behavioural therapy, multisystemic therapy
for juvenile delinquents, therapeutic communities, elec-
tronic monitoring and telepsychiatry in forensic psychia-
try settings. There is also evidence that post-incarceration
interventions such as assertive community treatment can
be cost-effective.
Conclusion: There remain large evidence gaps. There are
also challenges in turning economic evidence on mental
health interventions in criminal justice into policy changes
and improved practice, such as hidden costs, silo budgeting
O R I G I N A L A R T I C L E
Economic evaluations of mental health
interventions in criminal justice
Martin Knapp1 | Gloria Wong2
DOI: 10.1002/cbm.2286
Received: 3 March 2023 Accepted: 4 March 2023
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and
reproduction in any medium, provided the original work is properly cited.
© 2023 The Authors. Criminal Behaviour and Mental Health published by John Wiley & Sons Ltd.
https://wileyonlinelibrary.com/journal/cbm
http://creativecommons.org/licenses/by/4.0/
http://crossmark.crossref.org/dialog/?doi=10.1002%2Fcbm.2286&domain=pdf&date_stamp=2023-03-16
KNAPP and WONG140
1 | INTRODUCTION
The many links between mental health and criminal justice demand evidence-informed policy across sectors. Mental
(ill-)health and crime (both victimisation and perpetration) interact at various points: from risk of perpetrating crime to
the criminal behaviour itself, diversion or incarceration, and post-incarceration. There are significant economic costs
at each point on this pathway, as well as potential economic and other consequences of successful and unsuccessful
interventions.
Policy makers want reliable information on the relevant costs and outcomes of mental health interventions in the
criminal justice sector to support their decisions. In an earlier review by Frank and McGuire (2010, p. 1), inconclusive
evidence left unanswered the question: ‘is mental health treatment a cost-effective way to reduce crime and lower
criminal justice costs?’ Here, we provide an updated narrative review of economic evaluations—including cost-benefit
analyses where available—of mental health interventions in criminal justice. We approach this by looking at the links
between mental health and crime along the pathway in the criminal justice system (CJS) and review current evidence
in the context of challenges and responses in using economic evidence to inform policy.
1.1 | Analysis frame: Mental health interventions along the CJS pathway
People with mental health problems are more likely than the general population to come into contact with the CJS,
as victims or perpetrators of crime. Direct and indirect relationships between mental health and crime can occur over
a long period in life (Frank & McGuire, 2010).
Given the vast scope of the subject matter, we have limited our review to mental health interventions aimed at
perpetrators, although evaluations will usually aim to include victim costs of crime as well as CJS costs. By mental health
interventions, we refer to those targeting to ameliorate or prevent common mental disorders (often including mood and
anxiety disorders) and severe disorders (usually referring to psychotic disorders, but could also include severe mood
disorders). Substance abuse is also included. We have excluded behavioural problems in children and adolescents.
Within this scope, however, different types of mental disorders may be linked to different crimes and criminal
behaviours in different ways. For example, prison environments can also contribute to development or worsening of
psychopathology and suicidal ideation (Kutcher & McDougall, 2009; Sanislow et al., 2003), while violence can some-
times be caused by psychotic symptoms, although this is less common compared with indirect linkage through other
general risk factors (Skeem et al., 2011). We focus here on interventions that target aspects of mental health that are
considered as contributing to risk of offending/re-offending or criminogenic needs.
Based on this, mental health interventions can be categorised by their timing in relation to criminal behaviour:
1. Point of contact: Some criminal behaviours, such as violence, can be the direct result of psychopathology. Mental
health interventions can be delivered at this point.
and delayed pay-off. Research incorporating multi-sectoral
costs and benefits recommended by health economics and
health technology assessment groups should be prioritised
to support difficult resource allocation decisions faced by
policy makers.
K E Y W O R D S
cost-benefit, cost-effectiveness, health technology assessment,
implementation challenges, mental health economics, societal costs
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KNAPP and WONG 141
2. Post-arrest: Growing attention is being paid to the ethical problem of ‘criminalisation of mental illness’ and the
high costs associated with incarceration of people with mental illness (Delgado et al., 2020). This implies a need
to make comparisons between diverting for mental health interventions versus continuing a regular CJS pathway.
3. Incarceration/punishment: Interventions at this point refer to those designed for offenders/prison inmates with
mental health needs, including specific interventions in forensic psychiatry.
4. Post-incarceration: Interventions can be provided at/after release from prison for people with mental health prob-
lems, including follow-up services to avert future crime and improve health. ‘Recidivism’ is an issue at this point,
which can be related to system bias (e.g., stigma and close monitoring) in people with mental illness (Skeem
et al., 2011).
1.2 | Use of mental health economics to inform policy
Economic evaluations take various forms, but all compare resource expenditure (costs) with achievements (outcomes).
In health services research, where the primary concern is what achieves the best health gains for the population
(or specific population subgroups), the most common economic evaluation type is cost-effectiveness analysis. This
compares the costs and health gains (usually measured by symptom, functioning and/or wellbeing scales) of two or
more treatments or policies. It is very rare for health gains to be converted to monetary measures, in part because of
computational difficulties and in part because there are conceptual challenges, such as how to interpret differences in
willingness to pay (the basis for monetising health benefits) that stem from differences in individuals' characteristics,
such as socioeconomic status. Consequently, cost-benefit analyses are uncommon.
Of course, a treatment or policy that alleviates symptoms and thereby reduces future health service expenditure
would allow comparison of costs incurred with costs saved, but an analysis of that kind would generate only limited
evidence to inform resource allocation decisions because it does not assess impacts on health outcomes. To antici-
pate findings presented later in this paper, our review found few cost-benefit analyses of mental health interventions
in the criminal justice field, and none that attached monetary values to health outcomes.
To support resource allocation decisions, it is common for cost-effectiveness findings to be compared with
willingness-to-pay thresholds of the kind employed by health technology assessment bodies (e.g., the National Insti-
tute of Health and Care Excellence (NICE) in England) as the basis for making recommendations. Those comparisons
often use a generic outcome measure such as quality-adjusted life years (QALYs) to support strategic decision-making,
for example, for the healthcare system as a whole (see Knapp & Wong, 2020 for a more detailed discussion).
Regardless of methods, a major challenge in mental health interventions remains the large evidence gaps. We
highlight some key evidence below (see Table 1 for a summary).
2 | ECONOMIC EVIDENCE OF MENTAL HEALTH INTERVENTIONS ALONG THE CJS
PATHWAY
2.1 | Point of contact
The effectiveness of policing-related mental health interventions—such as liaison and diversion, street triage with
mental health professionals, and mental health professionals embedded in police contact control rooms—has been
reviewed (Kane et al., 2018). While these interventions seem to have positive impacts, the authors recommended
more rigorous evaluation. They found little cost-effectiveness evidence. For pre-arrest diversion in general, there is
a similar dearth of cost-effectiveness evidence. Some analyses suggest potential cost savings compared with tradi-
tional courts: for example, in a pilot neighbourhood outreach scheme in England, nurse-led screening of people with
suspected mental illness had an impact on both health and crime (Earl et...