POLICY EVALUATION AND STRATEGIC COMMUNICATION RESEARCH TO IMPROVE THE LIVES OF INDIVIDUALS WITH SERIOUS MENTAL ILLNESS AND CRIMINAL JUSTICE INVOLVEMENT

Individuals with serious mental illness and individuals with criminal justice involvement are at higher risk for poor health and social outcomes compared to the general population. The goals of this dissertation are: 1) to evaluate the effect of Maryland Medicaid health homes on emergency department (ED) and inpatient utilization; 2) to evaluate whether the effect of Maryland Medicaid health homes differs by an individual’s history of criminal justice involvement, and 3) to assess whether messaging can reduce social stigma toward individuals with a prior drug felony conviction and punitive policies that affect this population. Manuscript One identifies the impact of the Maryland Medicaid health home program on ED and inpatient utilization among individuals with serious mental illness (SMI). This study concludes that enrollment in health homes is associated with a decrease in the probability of having a somatic ED visit or an inpatient substance use disorder (SUD)-related admission and a decrease in the number of inpatient SUD admissions. It also finds that longer enrollment in health homes is associated with a decrease in in the probability of having a somatic ED visit, an ED SUD visit, or an inpatient SUD admission. Manuscript Two evaluates whether the effects found in Manuscript One differ by an individual’s history of criminal justice involvement. The study finds that longer enrollment in health homes among individuals with SMI and criminal justice involvement in the past three years resulted in smaller decreases in the probability of having a somatic ED visit compared to individuals with SMI and without criminal justice involvement in the past three years. Manuscript Three is a randomized experiment testing how message framing including the use of a sympathetic narratives affects public attitudes towards individuals with a felony drug conviction and punitive policies towards this population. This study finds that framing the challenges faced by individuals with a felony drug conviction as a social justice issue, public safety issue and having an impact on children reduced social stigma towards this population and improved support for less punitive policies. The addition of a narrative had a marginal effect of further reducing social stigma