Intensive case management as a jail diversion program for people with a serious mental illness: a review of the literature

Recommended Mental Health Practices for Individuals Interacting With U.S. Police, Court, Jail, Probation, and Parole Systems

OBJECTIVE

Tens of millions of individuals with mental health problems interact with the U.S. criminal legal system (including 911, police, jail detention and sentences, courts, and probation and parole) each year. The authors sought to identify recommended mental health practices for criminal legal system-involved individuals and report the percentages of U.S. counties and of the U.S. population living in counties in which each recommended practice is present.

METHODS

Recommended practices for criminal legal-involved individuals with mental health problems were identified from meta-analyses, reviews, and best practice recommendations. Up to four respondents per county (i.e., jail, probation, community mental health, and community substance use treatment administrators) from 950 counties were asked whether each recommended practice was present for criminal legal-involved individuals. Weighted percentages of U.S. counties using recommended practices and of the U.S. population living in counties with each recommended practice are reported.

RESULTS

Fifty-nine recommended practices, including general mental health approaches (e.g., permanent supportive housing, Medicaid continuity) and diagnosis-specific mental health treatments (including medications and psychotherapies), were identified. Weighted data from respondents (N=791 from 519 counties) indicated that each recommended practice was present for criminal legal-involved individuals in only 21.9%-43.0% of U.S. counties.

CONCLUSIONS

These results inform implementation efforts by indicating the presence of recommended care practices for criminal legal-involved individuals with mental health problems in counties nationwide. Because supportive housing, access to Medicaid reactivation in jails, and psychosocial interventions for physical pain have low presence but high importance for recovery, implementation efforts might first target these approaches.

Diversion Programs for Individuals Who Use Substances: A Review of the Literature

Diversion programs connect individuals to treatment instead of criminal sanctions and are used more frequently to address substance use. This systematic scoping review included 31 published empirical studies to examine evaluations of diversion programs that address substance use and misuse. We assessed the program characteristics and implementation settings, as well as the outcomes measured and study methods used. We identified five prevalent study outcomes categories: (a) Service utilization (program retention and completion), (b) Recidivism/criminality, (c) Substance use, (d) Psychosocial functioning, and (e) Other outcomes (e.g., trauma, quality of life, and housing). Findings demonstrated limited but promising evidence for improvements in recidivism, substance use, and psychosocial outcomes. The limited evidence may be partly due to heterogeneity in diversion program implementation, study designs used, and differences among subpopulations. Most studies examined postbooking diversion programs; therefore, further examination of alternative approaches such as prebooking diversion programs is needed to fully understand diversion program impacts.

El terapeuta ocupacional en el ámbito penitenciario colombiano

Introducción. Aunque el sector justicia es un importante campo de actuación de la terapia ocupacional, son pocos los trabajos que documentan los alcances y las experiencias profesionales en Colombia.Objetivo. Aportar información para comprender el desarrollo de la terapia ocupacional colombiana en el ámbito penitenciario.Materiales y métodos. Investigación cualitativa con revisión sistemática de literatura y aplicación de encuestas a siete expertos.Resultados. Priman acciones de formación e inclusión productiva y social, fortalecimiento del autocuidado y tiempo libre con población reclusa, siendo los talleres para formación en oficios la estrategia más utilizada. Son frecuentes los modelos de la ocupación humana y canadiense del desempeño ocupacional. La academia, las problemáticas sociales y el desarrollo legislativo figuran como referentes que marcan el transcurrir profesional en el sector. Se deben fortalecer las acciones con familia y redes y cambiar la percepción de debilidad en la experiencia profesional que manifiestan los terapeutas ocupacionales frente a su quehacer en penitenciarías.Conclusiones. Se debe fortalecer la terapia ocupacional en el sector justicia y reconocer la ocupación como eje fundamental en procesos resocializadores. Los derroteros sectoriales y los contenidos normativos afines visibilizan la ocupación como estrategia e indicador de cambios en una población que, habiendo transgredido las normas jurídicas, puede aportar a la sociedad con su potencial ocupacional y productivo.

The effectiveness of specialized legal counsel and case management services for indigent offenders with mental illness

BACKGROUND

In recent years, jurisdictions have recognized the strain placed on limited existing resources by criminal offenders with mental illness who frequently cycle through local jail facilities. In response, many locales have developed and implemented specialized programs to more effectively and efficiently manage these offenders, particularly the process of assigning defense attorneys to these often indigent defendants.

METHODS

The current study examined the impact of an Indigent Defense Counsel (IDC) program designed to provide specially trained defense attorneys, and enhanced case management services to 257 indigent jail inmates with a qualifying, major mental health diagnosis (e.g., major depression). These offenders were compared to 117 similar offenders who did not receive these services, on both their length of stay in the jail, and their likelihood of recidivism after release to the community.

RESULTS

Survival analyses revealed that program participants spent about 17 fewer days in jail; however, recidivism rates between groups, measured as return to the same county jail or as statewide re-arrest, did not differ.

CONCLUSIONS

These results suggest that defendants with mental illness can potentially be managed effectively in the community, with little added risk to public safety and at potential savings in jail bed days/costs. Implications for the processing of indigent criminal defendants with mental illness are presented.

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States

In the past decade, many constituencies have questioned the efficacy, cost, and unintended consequences of mass incarceration in the United States. Although substantial evidence now demonstrates that US incarceration policies have had unintended adverse health consequences, we know less about the strategies and policies that can prevent or reduce these problems for justice-involved individuals and how the criminal justice system (CJS) can contribute to the Healthy People 2020 national goal of eliminating inequities in health. This review examines strategies that have been used to improve the health of people at various stages of CJS involvement, including diversion from jail and prison stays into community settings, improvements to the social and physical environments within correctional facilities, provision of health and other services to inmates, assistance for people leaving correctional facilities to make the transition back to the community, and systems coordination and integration.

Screening and access to services for individuals with serious mental illnesses in jails

High rates of serious mental illnesses (SMI) among jail inmates pose challenges for the criminal justice system and risks for the individual with SMI. Research has identified actions to address these issues; it is unclear to what extent they have been operationalized. This study examines jails in one state, exploring how individuals with SMI are identified and treated, and comparing these with research-based recommendations. Results indicate that jails are not using evidence-based screenings, staff require training in SMI, access to services and medications for jailed individuals with SMI is often slow, and coordination between community providers and jails is limited.