Treatment as an Alternative to Jail for People with Mental Illness

By Rebecca A. Clay

Imagine you’re a police officer who spots a man trespassing, urinating in an alley, or engaging in some other illegal behavior. When you confront him, he mutters, won’t look you in the eye, and just seems a little strange. Not knowing what else to do, you put him in jail.

And there he sits, not getting treatment for what turns out to be a serious mental illness. The trauma of incarceration actually makes the man’s psychiatric problems worse. Soon after his release, he gets arrested again.

That’s just the kind of scenario that the Targeted Capacity Expansion Grants for Jail Diversion Programs is designed to prevent. Launched by SAMHSA’s Center for Mental Health Services (CMHS) in 2002, the program targets the unnecessary incarceration of nonviolent adult offenders with mental illnesses.

Instead, it uses police crisis intervention teams, mental health courts, and other strategies to divert people away from the criminal justice system and into community-based mental health and substance abuse treatment (see a grantee’s story).

“We want these individuals to receive appropriate treatment,” said U.S. Public Health Service Commander and Project Officer David Morrissette, Ph.D., LCSW, noting that forthcoming research from the U.S. Department of Justice (DOJ) suggests that 16 percent of inmates have serious mental illnesses. “We want to break the cycle of arrest, incarceration, and release.”

A Proliferation of Programs

Jail diversion programs for people with mental illness began as a response to the failures of deinstitutionalization, explained Henry J. Steadman, Ph.D., Director of the National GAINS Center in Delmar, NY. The CMHS-funded center, which includes the TAPA Center for Jail Diversion, collects and shares information about effective services for people with mental or substance abuse disorders who come in contact with the criminal justice system.

Twenty years ago, said Dr. Steadman, there was just a handful of jail diversion programs scattered around the country. Today there are nearly 500.

Federal funding from SAMHSA and other agencies has spurred that proliferation, said Dr. Steadman. “Before that,” he explained, “the movement didn’t have much oomph.” Since 2002, SAMHSA has made 34 jail diversion program grants.

The Model

Whether SAMHSA-funded or not, jail diversion programs typically focus on a particular point in the continuum of criminal justice involvement, said Dan Abreu, M.S., CRC, LMHC, Associate Director of the GAINS Center.

“How people encounter the criminal justice system is fairly linear, and at every point along the line you have opportunities to engage people in service,” he explained. “You want to prevent penetration into the criminal justice system.”

In fact, the field relies on a “sequential intercept model” developed with GAINS Center support by researchers Mark R. Munetz, M.D., and Patricia A. Griffin, Ph.D.

The model outlines five potential “intercept” points.

• Law enforcement and emergency services. The first opportunity occurs when the police encounter some sort of problem on the street. To take advantage of that opportunity, communities have developed crisis intervention teams. First developed in Memphis, TN, these programs give officers specialized mental health training and send them out to respond to any call that may involve people with mental illness.
• Initial hearings and detention. The first appearance in court is another opportunity to divert low-level offenders. Courts may hire mental health professionals or develop relationships with outside organizations to assess offenders and advise judges.
• Disposition hearings. To address more serious misdemeanors or felonies, many communities have developed specialized mental health courts or regular courts that focus on problem-solving and treatment rather than punishment.
• Re-entry. Sometimes a person slips through earlier intercepts and winds up in jail or prison. The point when inmates are returning to their communities represents another opportunity to connect them with services.
• Community supervision. Many communities have specialized parole and probation programs that ensure former inmates get the treatment they need and stay out of jail.

* Editors Note:
The graphic of the “Sequential Intercept Model” was created by Mark R. Munetz, M.D., and Patricia A. Griffin, Ph.D., of the SAMHSA-funded National GAINS Center. The graphic appears in “Use of the Sequential Intercept Model as an Approach to Decriminalization of People with Serious Mental Illness,” an article published by Psychiatric Services online. [Psychiatr Serv 57:544-549, April 2006 doi: 10.1176/appi.ps.57.4.544]