Methods: This exploratory study presents qualitative field notes from 20 county jails in one state regarding their response to the pandemic and a case study of one rural jail to examine changes in booking trends related to behavioral health needs over the course of three time periods: in the winter prior to the pandemic (February 15th – March 14th), during the spring when community spread was high (March 15th – May 23rd), and during the summer when community spread was relatively low (May 24th – August 1st). Bivariate analyses (chi-square, t-tests) assessed for changes in the population by demographics (sex, race/ethnicity, age), charge information (felony or misdemeanor/civil/ordinance), charge type (assaultive/violent, property, drug/alcohol, technical violation, or ‘other’), and past year recidivism. Behavioral health was assessed using the Kessler-6 (Kessler et al, 2001; 2002), and corroborated with questions about past year mental health treatment use and current use of psychotropic medications. Two validated screening questions for substance misuse were also asked on the screening instrument.
Results: Jails decreased their population via early releases, reconsideration of bond, and reductions in arrests. Prior to the pandemic, the rural jail averaged 34.5 bookings per week, which dropped during the spring (8.5/wk), and climbed back up during the summer (24.6/wk). Felony charges were significantly higher during the spring (50.5%, n=51), compared to the winter (32.4%, n=48) and summer (33.6%, n=83; χ2(2)=10.454, p<.005, V=.145). The jail population reported the highest proportion of past year recidivism in winter (48.6%, n=53), compared to the spring (35.7%, n=30) and summer (26.2%, n=50). The proportion of the jail population with mental illness was significantly higher during spring (40.5%, n=34) compared to the winter (29.7%, n=33), with the lowest being in summer (22.5%, n=43; χ2(1)=9.355, p<.01, V=.156). Substance misuse did not significantly vary across the three time periods.
Conclusions and Implications: Jail responses to the pandemic show that, initially, populations decreased but the rate of behavioral health needs of those who remained increased. Policy should mandate that jails provide access to behavioral health clinicians, while expanding diversion opportunities during and after COVID-19. Furthermore, innovations in continuity of care are critical for both behavioral health and public health needs given the high risk for suicide, overdose, and viral spread after release from jail.