County Jails' Responses to COVID-19: Practices, Procedures, and Provision of Behavioral Health Services

Background and Purpose: Early on in the COVID-19 pandemic, states mandated mitigation strategies for the general public, yet decisions regarding jails fell largely on local criminal/legal agencies. The physical layout of jails makes social distancing a difficult practice and healthcare providers within jails are not equipped to handle viral outbreaks (Akiyama et al, 202; Hawks et al, 2020). Furthermore, the rapid cycling of jail populations increases the risk of disease spread to staff and inmates, as well as the community. Concurrently, jails disproportionately incarcerate individuals with behavioral health issues, suggesting they are at increased risk for COVID-19. Therefore, this study asks, “How did jails respond to the COVID-19 crisis, and did jail population characteristics change related to behavioral health needs and criminal/legal history?”

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 15^th – March 14^th), during the spring when community spread was high (March 15^th – May 23^rd), and during the summer when community spread was relatively low (May 24^th – August 1^st). 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.