Jail diversion services for people with mental illness: What do we really know?

Date10 December 2002
Published date10 December 2002
AuthorRani A. Desai
Rani A. Desai
An accumulating body of research data points to the disproportionate
presence of persons with mental illness in America's jails. Preventing the
jail detention of people with mental illness has become an agreed-upon
goal for actors in both the mental health and criminal justice systems.
Toward that end, a variety of 'jail diversion' mechanisms have been
developed to move people with mental illness who commit low-level
misdemeanors away from the criminal justice system and into the mental
health treatment system. Despite the increasingly widespread adoption of
these programs, there is a lack of empirical data on their effectiveness,
although 'myths' regarding these programs abound. This paper describes
these programs, offers empirical data on their effectiveness, provides an
overview of the challenges they face, and suggests future directions for
This paper has
four major goals. The first goal is to briefly introduce readers to
the issue of criminal justice involvement among people with mental illness. The
second is to describe one approach to the problem, called jail diversion, and
Community-Based Interventions for Criminal Offenders with Severe Mental Illness,
Volume 12, pages 99-121.
Copyright © 2003 by Elsevier Science Ltd.
All rights of reproduction in any form reserved.
ISBN: 0-7623-0972-5
contrast it with "normal" criminal justice procedures. The third goal is to
critically compare some of the relatively unexamined myths about jail
diversion to the empirical data on their effectiveness. The final goal is to
examine what challenges are faced by both criminal justice and mental health
systems that attempt to establish and evaluate such programs, and to outline
future research directions.
It is well documented that a large proportion of incarcerated adults suffer from
mental disorders, and the proportions are increasing over time. The 1980
Epidemiologic Catchment Area Study, a large national study of the rates of
mental disorder in the general population, found that the rates of lifetime
mental disorder in prison populations were several times higher than the
general, non-incarcerated, population (Robins et al., 1991). For example, the
ECA study found that 6.7% of prisoners had a lifetime diagnosis of
schizophrenia, as opposed to 1.4% of the non-incarcerated general population.
In 1984, Teplin and colleagues estimated that among the 10.1 million jail
admissions a year in the U.S., approximately 6.6% were of people with serious
mental illness (SMI) (Teplin, 1984). Additional data collected on male inmates
at Cook County jail estimated that 9.5% had a lifetime diagnosis of
schizophrenia, mania, or major depression, compared to 4.4% of males in the
general population (Teplin, 1990b).
More recently, a national survey of jails conducted in 1992 by Torrey and
colleagues indicated that the proportion of SMI among people in jails or
prisons was much higher than 10 years earlier, particularly in larger urban jails
(Torrey et al., 1992). This national survey also indicated that incarcerated
people with SMI were less likely actually to be charged with a crime, were
more likely to be abused by other prisoners, and were more likely to refuse
medication while incarcerated (Torrey et al., 1992).
The Department of Justice, which has recently added mental health
questions to its regular surveys of prison and jail inmates, has reported that in
1998, 16% of State prison inmates, 7% of Federal prison inmates, and 16% of
those in local jails reported either a mental condition or an overnight stay in a
mental hospital at some time in their life. Furthermore, those inmates with
mental illness were more likely to report physical or sexual abuse as a child,
more likely to have alcohol or drug dependence, and were more likely to be
serving a sentence for a violent offense (Ditton, 1999).
The data on rising prevalence rates of mental illness in jails and prisons is
fairly undisputed. However, the reasons for this rise are less clear. Arguments

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