ST. LOUIS — A study published in PLOS One on July 8, 2026, established an association between criminal legal involvement and emergency department visits for any reason, substance use, and mental health. The research was conducted by Vidya Eswaran, a researcher affiliated with Washington University in St. Louis.

Researchers analyzed data from 139,524 adults who participated in the 2021–2023 National Survey on Drug Use and Health. This survey is a nationally representative, cross-sectional survey focusing on civilian, non-institutionalized U.S. residents. Participants self-reported their experiences with lifetime and past-year criminal legal involvement, as well as emergency department visits within the preceding 12 months for various reasons, including substance use and mental health.

The study defined criminal legal involvement as having been arrested and booked for breaking the law at any point. Current incarceration and housing-insecure individuals were excluded from the survey data.

Among those who reported an emergency department visit for any reason, 19% indicated lifetime criminal legal involvement, while 3% reported criminal legal involvement within the past year. Data specific to substance use-related emergency department visits showed that 44% of patients had lifetime criminal legal involvement, and 15% had past-year involvement. For mental health-related emergency department visits, 29% of patients reported lifetime criminal legal involvement, and 8% reported past-year involvement.

After statistical adjustments for sociodemographic and behavioral health factors, individuals with lifetime criminal legal involvement had higher odds of an emergency department visit for any reason, with an adjusted odds ratio (aOR) of 1.20 (95% CI 1.12–1.29). This group also showed higher odds for emergency department visits related to substance use (aOR 1.82, 95% CI 1.36–2.43) and mental health (aOR 1.54, 95% CI 1.19–1.99).

"In a nationally representative survey 1 in 5 individuals who have visited an Emergency Department (ED) report a history of lifetime criminal legal involvement (CLI), which is associated with adverse health outcomes," Eswaran stated. She added that "EDs are uniquely positioned to help address health disparities and should be considered as sites of screening and intervention in collaboration with community partners focused on improving outcomes in this population."