Assessing the Efficacy of Mental Health Jail Diversion Programs: A Multi-Site Study

Background: Individuals with severe mental illness (SMI) are overrepresented in the criminal justice system as jails and prisons have become the primary care facilities for individuals with SMI. Greater calls for “smart decarceration” strategies. nationwide mean that policy-makers are increasingly pursuing reform efforts like mental health jail diversion programs that can reduce the number of people – especially those with SMI – who are incarcerated. This study asked: What factors predict efficacy of mental health jail diversion programs (MHJDPs) as measured by three outcomes: post-program treatment engagement, continuity of care, and recidivism?

Methods: This study evaluates the efficacy of MHJDPs within eight county jails in Michigan. We assessed a range of predictor variables including demographic characteristics (age, gender, and race, county size), behavioral health indicators (co-occurring disorder, prior mental health treatment engagement, and client of a community mental health [CMH] agency), criminal/legal histories (charge severity, prior jail stay, and days spent in jail), and program characteristics (diversion type, dosage of services, and successful completion). We considered three post-program outcome variables: individuals’ mental health treatment engagement, continuity of care (treatment engagement within 14 days of jail release), and recidivism (a return to the county jail for any reason within one year). Individual-level data for each participant was compiled from four administrative data sources: program, Medicaid billing, county-specific jail, and state corrections data. We performed both bivariate (chi-square and t-tests) and multivariate (logistic regression) analyses.

Results: A total of 1,183 individuals participated in one of eight MHJDPs across the state. The majority of participants were male (69.9%, n=886), and white (53.5%, n=676), with an average age of 36.9 years old (SD=11.6). Four-fifths (79.2%, n=1003) had a co-occurring substance use disorder. For the first outcome, individuals who had a COD, were CMH clients, received past-year mental health treatment, and received early-release advocacy services were significantly more likely to engage mental health treatment services following MHJDP completion, while longer jail stays decreased this likelihood (χ²(10, n=900)=162.28, p<.001). For the second outcome, individuals who had a COD, were CHM clients, received past-year mental health services, received a higher dosage of program services, and successfully completed the MHJDP were significantly more likely to receive mental health services within 14 days of jail release (χ²(8, n=356)=66.44, p<.001). For the third outcome, individuals who had a COD and who had a prior jail stay were significantly more likely to return to jail in the year following MHJDP completion, while longer jail stays decreased this risk (χ²(4, n=1,062)=76.68, p<.001).

Implications: MHJDPs are an essential link between correctional and community-based mental health services. The findings of our study highlight the profile of individuals who have engaged in treatment after jail diversion, received mental health services soon after jail diversion, and recidivated in the year after jail diversion. This valuable information can inform institutional and community mental health providers, so they are more able to assist individuals and remove barriers to service use.