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Jail Diversion in North Carolina. February 2009 919 / 715-2771 or Bob.Kurtz@ncmail.net.

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jail diversion in north carolina
Jail Diversion in North Carolina

February 2009

919 / 715-2771 or Bob.Kurtz@ncmail.net


“What county officials and the public should know about the incarcerated mentally ill population is not just that these individuals will significantly benefit from a system of comprehensive services, such as housing, health, and human services, but that such a strategy would be less expensive and more effective in the long-term.”

- National Association of Counties Report titled: Best practices for diverting mentally ill individuals from county jails. - June 2003


Lack of services or barriers to service will increase the likelihood that people with mental illness

will end up in jail.

Penrose’s Law: There’s an inverse relationship between Severe & Persistent Mental Illness incarcerated and those in hospitals
psychiatric instability often results in legal problems
Psychiatric instability often results in legal problems…...
  • About 20% of people with SMI who have been treated and released from a psychiatric hospital are arrested within one year of discharge - compared to 5% life time arrest rate for the general population.
    • Usually the arrest is for minor crimes…
      • Trespassing
      • Public Intoxication
      • Disturbing the public order
      • Impeding the flow of traffic
      • Drug related offenses.
          • According to a recent Duke University study.
high rates of people with serious mental illness in jail
High Rates of People with Serious Mental Illness in Jail
  • Every year, about 800,000 people with severe mental illness are incarcerated in US jails.
  • More than 16% of people in US jails have a serious mental illness (compared to 5% in general population).
  • More than 4% of men in jail suffer from Schizophrenia or Bipolar Disorder-manic phase
  • Women in jail have almost double the rate of serious mental illness as men.
people with mental illness don t fare well in the criminal justice system
People with mental illness don’t fare well in the criminal justice system
  • Research shows that people with mental illness -
    • Are more likely to be arrested - In one study,47% vs. 26% for non-MI following police encounters.
    • Face more serious charges - Are often charged with more serious crimes than others for similar behavior.
    • Stiffer sentences - Are sentenced more severely than other people with similar crimes.
people with mental illness in the criminal justice system continued
People with mental illness in the criminal justice system continued...
  • Serve longer in jail and prison - Spend two to five times longer in jail and average 15 months more in prison.
  • Can’t make bail - Are often detained because they have no income and can’t make bail.
  • Have more difficulty coping - Experience more fights, infractions, and sanctions in prison
  • Are more vulnerable - To being exploited or manipulated by other inmates.
in north carolina jails
In North Carolina jails…...*
  • People with mental illness are often not identified when they enter jail:
  • There is quick access to emergency mental health care in jail, but limited access to hospital beds for mentally ill jail detainees:
  • Policies exist that violate mentally ill detainees’ rights / dignity:
  • Medications are often changed to a cheaper substitute in jail:
  • Communication / linkage between jail and community providers varies widely:

* Vaughn & Schyette, 2007, study of mentally ill in NC jails.

requirements of h b 1493 section 10 49 f
Requirements of H.B. 1493 - Section 10.49 (f)

“Within available resources….”

  • A statewide standardized evidence-based screening instrument shall be used when offenders are booked.
  • LMEs and county sheriffs shall work together to develop all of the following:

a. A designated LME employee who is responsible for screening the daily jail booking log for known mental health consumers.

b. Protocols for effective communication between the LME and the jail staff including collaborative development of medication management protocols between the jail staff and the mental health providers.

c. Training to help detention officers recognize signals of mental illness.

goals of jail diversion programs
Goals of Jail Diversion Programs
  • Preventing the inappropriate incarceration of persons with mental illness and co-occurring disorders.
  • Reducing jail time for people with mental illness who are inappropriately confined.
  • Linking detainees to appropriate mental health and community services following their release from jail.
jail diversion is not discharge planning or in jail treatment
Jail Diversion is notdischarge planning or in-jail treatment
  • Jail Diversion: Is a special program designed to help people with mental illness move from the criminal justice system to appropriate treatment in the mental health system.
  • In contrast -
  • Discharge / Transition Planning: Is part of the usual criminal justice process that occurs when the offender would ordinarily leave jail.
what do jail diversion staff do
What do jail diversion staff do?
  • Screen - detainees in contact with the criminal justice system for the presence of a mental illness.
  • Negotiate - with law enforcement, prosecutors, defense attorneys, and the court to develop community-based mental health treatment dispositions for clients as alternatives to incarceration.
  • Link - clients to community based mental health services, once the mental health disposition is determined and agreed on by all parties.
two categories of jail diversion initiatives
Two Categories Of Jail Diversion Initiatives
  • Pre-booking - Provide community based alternativesto arrest and incarceration. Most include a 24 hour crisis unit with a no refusal policy for law enforcement.
  • Post-booking - Following arrest and with the agreement of the court, involvement in treatment in the community.
when law enforcement responds to calls on people with mental illness
When law enforcement responds to calls on people with mental illness...
  • The arrest rate is 20% when no specialized response exists.
  • The arrest rate is 7% when some form of specialized response exists.
  • The arrest rate for the Memphis CIT program is just 2%.
    • Percent of incidents resolved on scene = 23%
    • Percent of incidents resulting in the person being transported to a crisis unit = 75%
comparisons of pre booking models
Comparisons of pre-booking models
  • Three models were examined to determine the proportion of police “mental disturbance” calls that resulted in a specialized response.
  • The results….
    • Birmingham MH “imbedded” model - 28%
    • Knoxville mobile crisis model - 40%
    • Memphis CIT model - 95%
        • Steadman, H., et.al, Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services, May 2000.
awards recognition for wake s cit program
Awards / Recognition for Wake’s CIT program
  • Program of Excellence 2006:

- NC Council of Community Programs

  • Agent of Change Award 2006

- Easter Seals UCP / ASAP

  • Outstanding County Program 2007

- NC Association of County Commissioners

  • CIT is a “Ray of hope in the system”

- News & Observer article quoting Verla Insko - State representative and chairwoman of the House Committee on Mental Health Reform.

mental health courts
Mental Health Courts
  • Are evolving rapidly
  • As yet, no evidence based conclusions
  • Steadman* recommends
    • A single court docket
    • Courtroom team approach
    • Specific plan manager
    • Assurance of treatment slots
    • Expanded services to avoid displacing others in need of treatment (I.e., earmark services for the court so other clients aren’t pushed out of service).
        • Hank Steadman, Ph.D., Director of Policy Research Associates and the TAPA Center, providing technical assistance to SAMHSA funded jail diversion programs.
what we ve learned about mental health courts
What we’ve learned about mental health courts……
  • Need to assure that there are expanded numbers of intensive treatment slots for MH Court clients.
  • Treatment that is court ordered needs to be consistent with what could be accessed without referral to the mental health court.
  • Referral to the mental health court should be reserved for those consumers who need the oversight of the court to remain compliant.
  • Should not exclude persons with mental illness who have a committed a violent offense.
continuum of jail diversion services
Continuum of jail diversion services.

Interaction with police





Pre-booking diversion (to crisis unit or other community service)






Released to

community after

sentence is served


Core Conceptual Model(Outcomes for jail diversion depend on a comprehensive mental health service system, and clients being effectively linked to that system)




Jail Diversion



divert from jail to

Divert from jail to??????

“Successful jail diversion efforts require more than simply diverting an individual with mental illness away from jail. He or she must also be diverted into appropriate and adequate treatment services.”

jail diversion requires a comprehensive responsible accountable mental health system

Jail diversion requires a comprehensive, responsible, & accountable mental health system!

“Poorly organized jail diversion programs lacking a mental health infrastructure produce short-term results that may harm the client and community.”

Integrated Treatment for People with co-occurring mental illness and substance abuse is particularly important for Jail Diversion clients.
  • More than 72% of people with severe mental illness who are in jail have a co-occurring substance abuse disorder.
jail diversion programs may benefit counties by
Jail diversion programs may benefit counties by….
  • Helping to alleviate jail over-crowding
  • Reducing costs of incarceration and unnecessary prosecution
  • Helping consumers get access to appropriate services
  • Providing support and incentives for staying in treatment
  • Helping end the cycle of repeated incarcerations and crisis care
north carolina jail diversion data
North Carolina Jail Diversion Data
  • Estimates by case managers in five jail diversion programs indicated an average of 3,174 jail days reduced per year per jail diversion program.
  • These data suggest an average of 8.7 fewer inmates in jail per year in those areas where jail diversion programs exist.
outcome data on clients in north carolina jail diversion programs for one year show
Outcome data on clients in North Carolina jail diversion programs for one year show…
  • Higher global assessment of functioning scores.
  • Report lower rates of substance abuse.
  • Lower rates of homelessness.
  • Greater satisfaction with housing.
  • Movement to more independent housing.
  • Higher rates of employment.
    • But rates of re-arrest and psychiatric hospitalization and inpt treatment for substance abuse were not reduced during that first year.
different interests
Different Interests
  • Mental Health Providers: Concerned with client’s emotional and psychiatric well being.
  • Jail: Concerned with safety. Group vs. Individual focus.
  • Defense Attorney: Often concerned with short term legal (instead of long term “best”) interests of client.
  • Judges: Concerned with community safety.
different constituencies



Defense Attorney--------



Mental Health staff------


Local Community



The Law (and electorate)

The wider community and sometimes federal judge

The client, family, advocates, local community, and state.

Different Constituencies
different language including different definitions of diversion

DIFFERENT LANGUAGE -including different definitions of diversion*

Justice system definition of diversion: To divert the criminal case out of the justice system and off the court docket. Judge’s may view this type of diversion as a criminal’s attempt to “get out of jail free.”

Mental health system definition of diversion: To divert the client from jail to the community mental health system. Deferred prosecution, continued court oversight, and (perhaps) mandatory treatment are included in this definition.

*To a judge, deferred prosecution is not diversion.

“The most effective way to improve your relationship with the justice system is to increase your understanding of it.”
  • Learn the “language” of the justice system
  • Know how the justice system functions in your community
  • Understand the culture of your law enforcement officers and jails.
  • Beware of the many challenges faced by those working in the justice system.
the benefits of working together
The Benefits of Working Together
  • Reduce jail days, reduces overcrowding, reduces overcrowded court dockets.
  • Reduces jail service expenses.
  • Reconnects people to services.
  • Coordinates services - reduces waste.
  • Gives people structure, allowing them to focus on recovery.
  • Increases Federal share of treatment cost.
for more information about jail diversion
For More Information about Jail Diversion
  • The Tapa Center is the organization contracted by SAMSHA to provide technical assistance to jail diversion programs. Contact them at: www.tapacenter.org or (866) 518-8272
  • The GAINS Center is a national organization that collects and disseminates information about effective services for people with co-occurring disorders in contact with the justice system. Access them at: www.gainsctr.com
  • The Consensus Project is an national effort to provide information, research and support to organizations attempting to help people with mental illness in the criminal justice system. It is sponsored by the Council of State Governments. They may be reached and their report downloaded at: www.consensusproject.org
  • Or Bob.Kurtz@ncmail.net or 919 / 715-2771