Treatment as an Alternative to Jail for People with Mental Illness
How well do such programs work? In the past, said Dr. Steadman, there have been few systematic studies examining the outcomes of jail diversion.
The challenges are enormous, he said. “A lot of these people live marginal lives, so it’s difficult to try to track them over time to see what happens,” he said. “And you can’t randomly assign people to jail diversion.”
Now Dr. Steadman and his colleagues are overcoming those challenges. They’re analyzing the effectiveness of 14 of the first 20 SAMHSA jail diversion grantees. Instead of a separate control group, he explained, “each case is its own control.” The researchers simply compared 579 participants’ reports of how they were doing the year before they entered the program and the year after.
The preliminary data look promising, said Dr. Steadman, noting that diagnoses included bipolar disorder, schizophrenia, and depression.
Seventy-five percent of participants had fewer arrests the year after their participation than the year before, for example. Factors that increased the likelihood of arrests included prior arrests, prior jail days, and illegal drug use. Housing status also played a big role, with stable housing related to fewer arrests.
The amount of time participants spent in jail also dropped. Fifty-two percent didn’t spend any time in jail in the year after participating in the program. Almost 76 percent reduced the number of days spent in jail post-enrollment compared with the year before diversion.
The preliminary analysis also shows that participants experience significant improvements in their functioning and significant reductions in their alcohol and illegal drug use, added Dr. Steadman.
Data also reveal something else: what Dr. Morrissette calls “an overwhelming number” of program participants who have experienced childhood sexual abuse, rape, or some other extreme trauma. SAMHSA now asks all existing jail diversion grantees to provide trauma services to participants.
In addition, the focus of the grant program itself has shifted to accommodate the discovery of trauma’s importance. The program currently focuses exclusively on offenders with PTSD or other trauma-related mental illness or substance abuse.
“When you think these days about whether there’s a large cohort of people who are experiencing significant trauma, you think about all the veterans who are coming back from Iraq,” said Dr. Morrissette. “As a result, we’ve given priority to serving veterans.”
In 2008, the new Jail Diversion and Trauma Recovery Program made its first grants to half a dozen states. These states will establish pilot programs in communities, learn from the experience, and then replicate the programs statewide.
Funding for more general jail diversion programs is still available—from DOJ’s Justice and Mental Health Collaboration Program.
“This is a really flexible program that lets communities take a look at their criminal or juvenile justice system continuum and identify where they have gaps and could be creating interventions,” said Ruby F. Qazilbash, M.P.A., Senior Policy Advisor for Substance Abuse and Mental Health at DOJ’s Bureau of Justice Assistance.
The 76 communities that have received grants since the program’s beginning in 2006 have developed specialized law enforcement response programs, mental health courts, “behind-the-walls” services within correctional facilities, and other diversion programs.
The Bureau of Justice Assistance also funds five Mental Health Court Learning Sites, which provide a peer support network for local and state officials.
“SAMHSA and DOJ are trying to leverage our resources as much as we possibly can so we’re making efficient use of our dollars and not duplicating each other’s efforts but complementing them,” said Ms. Qazilbash.
For more on jail diversion, visit SAMHSA’s Web site.
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