People with a history of criminal legal involvement are especially likely to visit an emergency department (ED) for drug use or mental health reasons, according to a new study published July 8, 2026 in an open access journal. Pro Swan By Vidya Eswaran and colleagues at Washington University in St. Louis, USA.
Criminal legal involvement (CLI), defined as having ever been arrested and charged with a law violation, is a known predictor of negative health outcomes, and incarcerated individuals suffer a high burden of chronic and comorbid conditions. Previous studies of ED utilization among patients with CLI have focused on cohorts with a known recent history of incarceration, rather than patients with lifetime CLI.
In the new study, researchers used data from 139,524 adults who participated in the 2021-2023 National Survey on Drug Use and Health. This national survey is a nationally representative cross-sectional survey of noninstitutionalized civilian U.S. residents. Participants self-reported lifetime and past-year CLI and ED visits in the past 12 months for any reason, including substance use or mental health.
Among those who reported visiting the emergency department for any reason, 19% reported lifetime CLI and 3% reported past year CLI. These rates were higher for substance use-related ED visits (44% lifetime CLI, 15% past-year CLI) and mental health-related ED visits (29% lifetime CLI, 8% past-year CLI). After adjusting for sociodemographic and behavioral health factors, lifetime CLI patients had higher odds of presenting to the emergency department for any reason (aOR 1.20, 95% CI 1.12 to 1.29), substance use (aOR 1.82, 95% CI 1.36 to 2.43), and mental health (aOR 1.54, 95% CI). 1.19 to 1.99).
The true prevalence of CLI among ED patients may be higher than these findings suggest because this study excluded currently incarcerated and housing unstable individuals, two populations more likely to suffer from CLI and those more likely to use the ED. The authors conclude that CLI history should be recognized as a social determinant of health that shapes patterns of ED use, particularly drug use and mental health care.
The authors add: ”A nationally representative study found that one in five emergency department (ED) visits reported a lifetime history of criminal legal involvement (CLI), which is associated with negative health outcomes. EDs are uniquely positioned to help address health disparities and should be considered as sites for screening and intervention in collaboration with community partners focused on improving outcomes for this population.”
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Reference magazines:
Eswaran, V. others. (2026) Prevalence of criminal legal involvement among emergency department patients: Insights from the 2021-2023 National Survey on Drug Use and Health. PLoS One. DOI: 10.1371/journal.pone.0351233. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0351233
