270093 Effects of brief incarcerations on jail diversion outcomes for people with serious mental illness

Tuesday, October 30, 2012 : 10:50 AM - 11:10 AM

Allison G. Robertson, PhD, MPH , Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
Marvin S. Swartz, MD , Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Hsiu-Ju Lin, PhD , CT Dept Mental Health & Addiction Services, Research Division MS # 14 RSD, Hartford, CT
Linda K. Frisman, PhD , CT Dept Mental Health & Addiction Services, Research Division MS # 14 RSD, Hartford, CT
John Petrila, JD, LLM , Department of Mental Health Law & Policy, College of Public Health, University of South Florida, Tampa, FL
People with mental illness are critically overrepresented in the US criminal justice system, where two million people with serious mental illness (SMI) enter US jails each year. Jail diversion is a growing public policy response in which people with SMI are diverted away from the criminal justice (CJ) system and instead into community treatment. Connecticut is one of two states with statewide jail diversion, occurring mainly in arraignment courts. Diversion clinicians suggest that judges may first place some individuals in jail for a few days to enhance their motivation to comply with treatment and diversion program requirements. This study assesses how brief jail stays before initiating diversion v. immediate diversion: 1) increase participants' treatment adherence and reduce use of crisis-driven health care, 2) reduce recidivism, and 3) increase program cost-effectiveness.

The study uses administrative records from public mental health, CJ, and Medicaid agencies for approximately 2,000 adults with SMI who participated in Connecticut's jail diversion program during 2005-2007. Quasi-experimental analyses estimate the effect of jail time before diversion on health and CJ outcomes, and calculate cost-effectiveness ratios for each jail diversion condition. Direct observations of jail diversion court proceedings and informal, semi-structured interviews with key diversion personnel provide insight into how brief incarceration before jail diversion may be used and its perceived effects. The immediacy of incarceration at arraignment imposes an important legal lever to engage offenders with SMI in treatment, and the results of this study provide important information regarding legal practices intending to optimize jail diversion participants' outcomes.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy

Learning Objectives:
1. Describe people with serious mental illness who participate in a statewide jail diversion program, including clinical and demographic characteristics, types and intensity of criminal justice involvement, and how these characteristics vary by pre-diversion jail status. 2. Identify how brief, pre-diversion jail stays affect jail diversion program participantsí subsequent use of crisis-driven health care services and criminal justice involvement. 3. Assess the extent to which brief, pre-diversion jail stays before initiating jail diversion program participation affect program cost-effectiveness.

Keywords: Mental Illness, Criminal Justice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an academic health services researcher with substantial methodologic training and research experience in mental health services research, including topics related to criminal justice involvement among this vulnerable population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.