According to the Substance Abuse and Mental Health Services Administration (SAMHSA) (2015), 800,000 individuals with serious mental illness are incarcerated annually in the United States. Further, 72% of this population meets criteria for a co-occurring substance use disorder (SAMHSA, 2015). As discussed in a previous blog post, police officers and the criminal justice system have become the main provider of mental health services due to limited community mental health services and resources (SAMHSA, 2015). Additionally, the advent of the “War on Drugs” in 1968 by President Nixon led to the criminalization of drug use and addiction, leading to huge increases in the number of people incarcerated (Center for Health & Justice, 2013). For example, in 2008, the number of incarcerated people had increased 5-fold without comparable decreases in crime or drug use (Moore & Elkavich, 2008). However, incarceration is incredibly costly, and it is estimated that the lifetime cost of incarceration for 1 person in the Texas criminal justice system is $2 million (Hogg Foundation for Mental Health, 2011). Therefore, jail diversion programs are gaining popularity across the United States, and recently in Texas, as an economic alternative (Center for Health & Justice, 2013).
According to SAMHSA (2015), jail diversion refers to “programs that divert individuals with serious mental illness (and often co-occurring substance use disorders) away from jail and provide linkages to community-based treatment and support services.” There are generally two types of jail diversion programs: pre-booking and post-booking (Senate Committee on Criminal Justice, 2014). Pre-booking diversion programs involve the identification of people with serious mental illness and/or addiction by law enforcement agents before arrest, and transportation to a crisis intervention center instead of jail (Senate Committee on Criminal Justice, 2014). Therefore, mental health services are provided in lieu of criminal charges, and lowers the jail costs and court costs substantially (Drain & Solomon, 1999; Senate Committee on Criminal Justice, 2014). This model require partnership between law enforcement agents and mental health providers within the community, and would include programs previously discussed like Crisis Intervention Teams within local or county police departments (Center for Health & Justice, 2013).
Post-booking jail diversion, which is more widely used, identifies people with serious mental illness and/or addiction after they have been arrested and booked in jail (Senate Committee on Criminal Justice, 2014). This model is usually associated with speciality courts like drug court or mental health court, but it may also be associated with mental health assessment by correction officers or emergency services personnel within the jail (Drain & Solomon, 1999; Senate Committee on Criminal Justice, 2014). Therefore, post-booking diversion programs can range from deferred prosecution and community based treatment to arraignment, conviction and/or probation (Center for Health & Justice, 2013).
Due to the variance in jail diversion programs, and a lack of overarching standards for collecting and publishing data, there is limited literature on the effectiveness of jail diversion programs (Center for Health & Justice, 2013). However, some research suggests that jail diversion programs reduce the number of days spent in jail, increase the number of days spent in the community and leads to lower criminal justice costs (Steadman & Naples, 2005). However, a more recent literature review found that while jail diversion programs decrease the number of days in jail, they do not have any impact on rates of recidivism (Sirotich, 2009). Therefore, further research is needed to thoroughly examine common sets of performance measures like cost savings or reduced recidivism. Drain & Solomon (1999) suggest conducting a randomized trial that randomly assigns offenders to a diversion program or jail. However, this would necessitate considerable training of police officers to reliably assess inclusion and exclusion criteria in order to evaluate a pre-booking diversion program.
In 2004, the Texas House passed bill 2292, which states “a local mental health authority shall ensure the provision of assessment services, crisis services, and intensive and comprehensive services using disease management practices for adults with bipolar disorder, schizophrenia, or clinically severe depression and for children with serious emotional illnesses.”
In 2010, the Texas Department of State Health Services conducted a study to assess the efficacy of post-booking jail diversion programs for offenders currently in prison, on parole and on probation. According to the Texas Department of State Health Services (2010), approximately 23% of people in the Texas prison system have also been served by the mental health system. Refer to figure 5 for the breakdown of mental health diagnoses within the study population.
According to the Texas Department of State Health Services report (2010), 15% of those diverted to community mental health services had fewer psychiatric hospitalizations, 36% had less functional impairment, 32% had fewer employment problems, 31% had less housing instability and 28% had less co-occurring substance use. However, the report found that this type of diversion program should not be considered cost-saving, so much as cost-diverting (Texas Department of State Health Services, 2010). Therefore, in order to adequately execute jail diversion programs, an increase in community mental health service funding will also be necessary.
Interestingly, San Antonio and Bexar County have been implementing a jail diversion program since 2003 in order to reduce costs; in fact, it is estimated that the jail diversion program has saved the city more than $10 million annually (Moser, 2014). Cumulatively, this has diverted approximately 17,000 people from jails, reduced overcrowding and saved Bexar County approximately $50 million since it’s inception in 2003 (The Center for Health Care Services, 2015).
Currently, Fort Bend County, a county outside of Houston, is requesting $1 million in order to create a jail diversion program for 10-20 individuals. According to the proposed policy, HB 2597, the program must include the following components:
|(1) caseload management;|
|(2) multilevel residential services; and|
|(3) easy access to:|
|(A) integrated health, mental health, and|
|chemical dependency services;|
|(B) benefits acquisition services; and|
|(C) multiple rehabilitation services.|
Of note, the current policy proposal would be considered a post-booking jail diversion program, as it would provide social, clinical, housing and welfare services for people with mental illness upon release from jail. While this type of program is slightly different from the jail diversion programs reviewed so far, this type of program is essential as previously incarcerated individuals are extremely limited in terms of housing and employment options, which also limit access to social and mental health services.
While there are significant limitations and gaps in terms of empirical support for pre-booking and post-booking jail diversion programs, preliminary research suggests that these programs can improve clinical outcomes like functional impairment, as well as social outcomes like employment and housing. Further, research suggests that jail diversion programs can save tax payer dollars by decreasing criminal justice costs. While some argue that jail diversion programs actually divert costs to the mental health care system, one could argue that these costs are more justified as they led to the improvement of quality of life for both offenders and communities. In conclusion, we look forward to seeing more research support for jail diversion programs in the future, as evidence based interventions are a cornerstone to high-quality social work.
Center for Health and Justice. (2013). A National Survey of Criminal Justice Diversion Programs and Initiatives. Retrieved from http://www.napsa.org/diversion/library/No%20Entry-%20A%20National%20Survey%20of%20Criminal%20Justice%20Diversion%20Programs%20and%20Initiatives%20-%20CHJ%202014.pdf
Drain, J., & Solomon, P. (1999). Describing and evaluating jail diversion services for persons with serious mental illness. Psychiatric Services, 50(1), 56-61.
Hogg Foundation for Mental Health. (2011). Crisis Point: Mental Health Workforce Shortages in Texas. Retrieved from http://www.hogg.utexas.edu/uploads/documents/Mental_Health_Crisis_final_032111.pdf
Moore, L. D., & Elkavich, A. (2008). Who’s using and who’s doing time: Incarceration, the war on drugs, and public health. American Journal of Public Health, 98(5), 782.
Moser, W. (2014). San Antonio Reduced Its Jail Population by Treating the Mentally Ill. Chicago Magazine. Retrieved from http://www.chicagomag.com/city-life/August-2014/San-Antonio-Reduced-Its-Jail-Population-By-Treating-the-Mentally-Ill/
Sirotich, F. (2009). The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. Journal of the American Academy of Psychiatry and the Law Online, 37(4), 461-472.
Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral sciences & the law, 23(2), 163-170.
Substance Abuse and Mental Health Services Administration. (2015). What is jail diversion? Retrieved from http://gainscenter.samhsa.gov/topical_resources/jail.asp
Texas Department of State Health Services. (2010). Another Look at Mental Illness and Criminal Justice Involve in Texas: Correlates and Costs. Retrieved from http://www.dshs.state.tx.us/WorkArea/DownloadAsset.aspx?id=8589953608
The Center for Health Care Services. (2015). Jail Diversion Program. Retrieved from http://www.chcsbc.org/innovation/jail-diversion-program/