Medical clearance and psychiatric assessment: Key Concerns for Effective Jail Diversion for Persons with Mental Illness

n 2003 Bexar County, Texas (United States of America), fully implemented a jail diversion program (“BCJD”) for persons with mental illness that, unusually, incorporates both major components of diversion, a pre-booking component and a post-booking component. The BCJD also combines one feature common to jail diversion programs, psychiatric assessment, and a feature that is unusual, medical clearance that is readily available at the point of diversion.

As BCJD has evolved, we have found the medical clearance feature of the program to be critical to ensuring both that patients receive appropriate care in a timely fashion and that scarce resources are used efficiently. Patients who present for diversion are always accompanied by a peace officer; the peace officer by law is obliged to ensure that any injury or medical need is attended to before processing the person further. Without being able to obtain medical clearance at the site of diversion, police officers must escort the patient under custody to another site, typically an emergency department, to obtain medical clearance. Thus, without on-site medical clearance patients may experience delay in receiving necessary medical care and considerable peace officer time is expended in accompanying the patient.

In this presentation we will explore the advantages of the medical clearance feature of the BCJD and how it could be applied in criminal justice diversion settings elsewhere.