Comparing the Experiences of Individuals with Mental Illness to Those without Along the Criminal/Legal Continuum: An Eight County Study

Background: The Bureau of Justice statistics reports approximately 10.6 thousand admissions to local jails annually (Zeng, 2018), with individuals with a serious mental illness (SMI) being an over-represented population (Huh, 2018). Research has shown that traditional criminal/legal interventions are ineffective with the SMI population, and that these individuals can often be better served in the community at lower costs without increasing the risk to public safety. To identify stages where individuals with SMI can be diverted from the criminal/legal system and back into community-based services, scholars created the Sequential Intercept Model (SIM; Griffin et al., 2015). Using the five intercepts of the SIM as a framework, this study compares outcomes at each intercept for individuals with SMI to those without SMI to understand current disparities existing along the criminal/legal continuum. 

Methods: In 2017, eight county jails delivered a mental health (MH) screening instrument (Kessler-6) to everyone booked into the jail and also tracked those the jail identified as having a MH need. Demographic, behavioral health history, and criminal/legal history were also collected. A weighted subsample of individuals was followed for 14-months post-booking, to assess length of stay in jail (intercept 2), sentenced to prison/jail (intercept 3), re-entry continuity of MH care (intercept 4), recidivism for violations (intercept 5), and law enforcement encounters (intercept 1). Logistic regression models were conducted at each intercept to assess how SMI status impacts each outcome. Control variables include factors significant at the bivariate-level: gender, housing security, county size, prior jail stay, target charge severity, community mental health client, and prior mental health history. Multiple administrative data sources were used (i.e. county jail, Medicaid, state court, and state corrections). 

Results: A sample of 1,160 individuals were included in this study. After controlling for other variables in the logistic regression models, individuals with SMI had 1.7 times greater odds of having stays above the 30 day mean compared to Non-SMI individuals (χ²(7, n=1,047)=86.774, p<.001). Individuals with SMI were equally as likely to receive continuity of care for mental health services as individuals without SMI (χ²(9, n=735)=108.884, p<.001). Individuals with SMI were equally as likely as Non-SMI individuals to be sentenced to prison/jail (χ²(7, n=384)=73.254, p<.001). Individuals with SMI were equally as likely to recidivate on a violation as Non-SMI individuals (χ²(7, n=439)=68.051, p<.001). Individuals with SMI had a similar number of law enforcement contacts as those without SMI at the bivariate level; therefore, no regression analyses are presented.

Conclusions: This is the first study to follow individuals through the SIM, and to compare individuals with SMI to those without SMI. Individuals with SMI spent nearly twice as long in jail; however, there were no differences in the rates of prison/jail sentences, continuity of care, recidivism on a violation, nor police encounters. Our analyses suggest that communities build in more pre-booking diversion opportunities and advocacy efforts for early jail release. Improvements should also be made to jail- and community-based access to treatment for individuals with SMI, which can come through collaborative efforts across criminal/legal and mental health systems.