Gender Differences in Behavioral Health Treatment Utilization Among Arrestees

Background and Purpose. Behavioral health treatment is underutilized among the criminal justice system-involved population despite the high proportionality of offenders with substance use disorders, mental illnesses, and co-occurring disorders. Previous research has found associations between offenders’ likelihood of treatment utilization and particular demographic characteristics such as race, age, and education level as well as other background characteristics like previous arrest and severity of substance use (Hunt, Peters, and Kremling, 2015). However, studies that examine the factors that influence treatment utilization among legal system-involved women are lacking. Identifying any gender differences in behavioral health treatment utilization is critical, as it may inform ways to close treatment gaps, especially for justice-involved women. Thus, the objectives of this study are to examine gender differences among arrestees in: 1) predictors of receiving behavioral health treatment and 2) influential factors in barriers to treatment.

Methods. A total of 16,641 adult males and 8,351 adult females (N = 24,992) with a history of being arrested and booked in their lifetime were sampled from years 2012-2014 of the U.S. National Survey on Drug Use and Health (NSDUH). Logistic regressions examined past substance abuse (SA) treatment; past year mental health (MH) treatment; and past year combined substance abuse and mental health (SA/MH) treatment using female arrestees and male arrestees separately as subpopulations. Predictor variables included age, race/ethnicity, number of past year arrests, community supervision status, offense type, substance dependence, mental illness severity, education level, employment status, public assistance receipt, health insurance coverage, and geographic area. The relationship between gender and reasons for treatment gaps were examined through chi-square analysis.

Results. Regression results indicate that past year arrests, community supervision status, and substance dependence significantly increase both sexes’ odds of SA treatment utilization, as does being divorced for women and being Hispanic for men. Employed women, older men, and men with children had significantly lower odds of receiving SA treatment relative to their reference groups. Mental illness severity, government assistance, and health insurance coverage increased the odds of MH treatment utilization for both sexes while full-time employment and low levels of education reduced both sexes’ odds of MH treatment receipt. Middle-aged women and women on parole (though not probation) had significantly higher odds of MH treatment utilization while all racial/ethnic minority women had significantly lower odds relative to white women. Lastly, women arrested three or more times had the highest odds of receiving SA/MH treatment in the past year while Black women had the lowest odds. Chi-square analysis also revealed that gender differences in treatment utilization stem primarily from women arrestees’ fear of stigma, readiness to stop using, and the cost burden of treatment.

Implications. High arrests among comorbid women, minority women’s underutilization of MH treatment, and community supervision’s strong influence in people’s utilization of treatment point to a need to expand community-based alternatives to incarceration, and to strengthen probation/parole officers’ support competencies with increased motivational interviewing and cultural humility training. Implications for social policy are also discussed.