Why diversion and treatment programs for mentally ill inmates must be improved

While diversion and treatment programs exist for inmates who suffer from mental illness, they remain questionably effective


The majority of officers working on patrol or in jail for any substantial length of time know their frequent flyers on a first name basis. Often, knowing that repeat offender on a first name basis and having a working rapport can be advantageous for the officer, whether it be on the street or in booking at the jail.  For the arrestee however, returning to custody once again isn’t usually beneficial.

In the decades since the governmental closure of mental health facilities across the United States, the mentally ill population has soared. The belief that medicating offenders and introducing them to psychiatric services just prior to release would suffice long term to keep them out of jail has failed completely.

Return to custody

The United States prison system is the largest in the world. Recent statistics reflect 756 incarcerated per 100,000 people in the United States alone. Once released, two-thirds of the incarcerated will reoffend and land back in jail within three years of release. About half of incarcerated individuals in the U.S. have a mental illness. This reflects half of the estimated 2.2 million inmates that require mental health care while in jail. To complicate matters, approximately 70 percent of those individuals have a primary or co-morbid substance abuse disorder requiring treatment.

Recidivism rates have increased over 50 percent among the mentally ill population, and recidivism statistics for individuals with both co-occurring mental illness and substance abuse problems has increased to approximately 68 percent. The incarcerated with mental illness are housed for longer durations than those without. They are typically incarcerated for very minor offenses such as disorderly conduct, disturbing the peace or trespassing.

Shortfall

The incarcerated mentally ill population is often inappropriately treated due to a lack of understanding or knowledge of this mental health population. Prisons are not equipped for the mentally ill no matter how you look at the issue and continue to fall horribly short of meeting acceptable standards of care. Often the short falls arise due to conflicts of interest between care providers and required security protocol.

Today's prison system is both a necessity to keep the public safe and must serve as punishment for criminal behavior. Mental health care for the inmate population is expensive, but an absolutely vital piece of service within the correctional system. However, it is not the treatment cure for the skyrocketing recidivism rates.

What are the options?

Several community programs have surfaced as options to elevate heavy sentencing for the incarcerated mentally ill and to make an attempt to find solutions to a never-ending conundrum of jail overpopulation and poor in-custody treatment options.

One of the more recent alternative sentencing options is the development of the problem-solving court. This alternative sentencing option was created to address the underlying issues within each individual that ultimately resulted in their criminal behavior. The common types of problem-solving courts include drug courts, mental health courts, domestic violence courts and DUI/ DWI court.

Problem-solving courts

The intention of the problem-solving court is to use the court’s authority to reduce criminal behavior by changing the offender's behavior. The court format is typically diversionary where the participant agrees to closely follow guidelines as determined in order to avoid prosecution and incarceration.

Drug courts often offer counseling services which are heavily utilized by participants. Other services offered through adult drug or mental health court include housing assistance, job training and medications for treatment of addiction.

Program cycles run between six months and one year, with many participants willing to remain longer than required in order to graduate. Program graduation requires the participant to remain drug free and arrest free for the duration.

The problem-solving court programs have levels in which the participant is advanced through by clearing drug tests, meetings with judicial staff or clinical staff and completing tasks. Through completion of these tasks and attendance of court appearances is where the court holds participants accountable for their progress. Failure to meet any of the detailed criteria can result in a variety of consequences ranging from writing essays to being remanded back into jail and imposition of traditional sentencing. 

Two problem-solving court models

The two general problem-solving court models are a deferred prosecution and post-adjudication programs.  

In a deferred prosecution, the subject must meet eligibility requirements for the program prior to pleading to charges. Should the defendant fail the court diversion program and reoffend or violate the terms, they are prosecuted on the original charge.

In the post adjudication model, the subject pleads guilty to their charges and accepts a suspended sentence while in the court program. Should the defendant fail to complete the court program, they must appear in court again and face sentencing. If the defendant successfully completes the diversion program, the original sentence is waived and the charges are potentially expunged from record.

Questionably effective

In the states of Florida and Missouri, statistics reflected a substantially lower recidivism rate among drug court graduates over a 24-month period of tracking. These numbers reflect a reduction in rearrest rates of 70 percent in Florida and 31 percent in Missouri.

Analysis of a random selection of 76 different drug courts only found a 10 percent reduction in rearrest.  Other studies reflected a 13 percent reduction in recidivism for new offenses.  There are even further studies which showed little or zero impact of the drug court programs.

It appears that the statistics reflecting the problem-solving court programs’ ability to reduce recidivism among participants is varied and inconsistent. Program design, content and focus could be contributing to these erratic results. Revision and redesign of these programs may very well improve potential success swiftly.

Criminal justice and mental health professionals have requested improved diversion efforts. Successful cohesion between mentally ill offenders and appropriately paired community programs, mental health providers and addiction services could very well hold the key to break the continued population cycle through jails. However, even with great efforts across all involved systems, that key has yet to be found.

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