28 Locked out twice: How incarceration history shapes healthcare access for adults with mental illness

Objectives/Goals: A history of criminal incarceration in prison or jail is rarely considered in planning health services for individuals with mental illness. We estimate the impact of a history of incarceration on access to health care when needed among adults with mental illness. Methods/Study Population: Cross-sectional data from n=3,796 adults ages 32 to 42 who had been diagnosed with a mental illness were drawn from Wave 5 of the National Longitudinal Study of Adolescent to Adult Health database. Access to health care when needed was measured by answering the question “In the past 12 months, has there been any time when you thought you should get medical care, but you did not?” Regression-adjusted inverse probability of treatment weighting was used to adjust analyses of use of health care when needed for measured differences between individuals with prior incarceration (n=536) and those with no prior incarceration (n=3,260). Interaction terms were used to assess whether insurance, health and social status, chronic illness, and social support moderate the association between incarceration and unmet healthcare need. Results/Anticipated Results: After balancing group characteristics, individuals with a prior incarceration were 7 percentage-points (20%) more likely to have not received health care when needed during the past year (42% in those with prior incarceration versus 35% in those without prior incarceration; p<0.015). Weighted logistic regression models confirmed that incarceration history was significantly associated with unmet healthcare need (p<.05). Predicted probabilities ranged from 28-52% among those never incarcerated to 32-66% among those with incarceration histories. Marginal effects revealed that poor self-rated health, low self-rated social standing, and social support from family or friends amplified this association (p<.05). Discussion/Significance of Impact: A history of incarceration was associated with decreased access to healthcare when needed. Translational efforts to reduce disparities in healthcare access among adults with mental illness should include tailored models of care for individuals with incarceration histories.