Study finds link between treatment programs and reduced jail population, lower chance of recidivism

Diverting individuals with mental health disorders into treatment programs rather than simply jailing them not only significantly reduces the jail population but also lowers the chances of recidivism among offenders, according to a five-year study conducted by the Center for Behavioral Health and Justice at Wayne State University’s School of Social Work and released by the state of Michigan.

Titled “Mental Health Across the Criminal Legal Continuum: A Summary of Five Years of Research in Ten Counties” and based on research conducted between 2014 and 2019, the study examines the impact of a series of pilot intervention programs and improved jail-diversion efforts executed in several Michigan counties and calls for greater investment in mental health and drug treatment statewide.

The programs in the study, which were organized by the Michigan Mental Health Diversion Council, focused on five key areas of interaction between the criminal justice system and offenders facing substance abuse and mental health challenges — initial arrest by law enforcement, early jail detention and court hearings, access to jail-based services, the prison/jail re-entry process, and parole/probation.

According to the study, 54% of all individuals booked into jails in the target counties reported some variation of a substance abuse problem, while 45% described themselves as housing insecure and 42% said they had been recently incarcerated. Meanwhile, 34% had some indication of mental illness.

The report makes several other key findings:

• Individuals struggling with both serious mental illnesses and substance abuse were twice as likely to be recidivists than those with only a mental health problem;

• On average, offenders with serious mental illnesses spent 14 days longer in jail than those without serious mental health problems;

• Law enforcement officers who received increased training on how to deescalate conflict with mentally ill offenders were better able to identify mental illness and less likely to use physical force;

• Forty-four percent of offenders identified as having serious mental health issues were released from jail during non-business hours (5 p.m. to 8 a.m.), making it virtually impossible for them to get immediate access to much-needed treatment services;

• Teaching de-escalation techniques to corrections officers resulted in a 50% decrease in incidents in which offenders had to be forcibly removed from jail cells;

• Most counties in the study that increased mental-health treatment saw an attendant reduction in recidivism (e.g., in one populous county, the 13% increase in offenders’ engagement in mental health treatment
accompanied a 14% reduction in recidivism);

• Nearly 65% of those who received jail-based services entered into treatment programs after their release, whereas only 31% of those who didn’t receive services in jail entered treatment after being freed.

“More than just a collection of data, this report offers us an early roadmap to drastic improvements in how our criminal justice system handles issues of mental illness and substance abuse,” said Sheryl Kubiak, dean of the Wayne State School of Social Work and the principal investigator for the study. “In addressing these issues, we also give ourselves opportunity to address many of the problems that these issues underlie, including jail overcrowding, poor access to mental health, and drug treatment and recidivism.”

The study unfolded in two phases. The first phase focused on the development of pilot intervention projects designed to re-direct those with serious mental health issues into treatment, rather than just have them sit behind bars.

Phase one of the study focused on each county’s choice of one or more of the following interventions: use of alternative outpatient treatment efforts, the training of local police and other first responders to be part of “crisis intervention teams” (CIT) that deescalate run-ins with mentally ill offenders in order to divert them from jail into effective treatment, and consideration of a “centralized crisis assessment” facility where offenders with mental illnesses could be sent in lieu of jail.

The first phase resulted in programs heavily focused on jail-based interventions — including access to psychotropic drugs, housing and help from mental health professionals — for those in jail and those preparing to be released, as well as training of law enforcement officers that focused on diversion from jail.

Whereas phase one centered on pilot programs, phase two focused heavily on the development and/or improvement of countywide diversion efforts across all five of the key points at which mentally ill individuals intersect with the justice system.

The study found that many of the diversion initiatives had swift impact, not only on jails but also on hospitals and other health centers, which are often overburdened. For instance, in one Southeastern Michigan county — the sole county participating in the study that had access to a 24-hour crisis center for the mentally ill — only 9% of calls to the county sheriff’s department resulted in individuals being taken to the crisis center prior to the introduction of CIT training. The remaining 91% were sent to a hospital emergency room.

After CIT training, however, the number of individuals taken to the crisis center rose to 31%, while the number of those taken to emergency rooms dropped to 69%.

The study also underscored the need to develop more thorough screening tools to identify mental health issues among offenders upon their initial detention in jail and their early interactions with the courts. Currently, the report notes, “jails may rely on a single question (i.e. ‘Are you suicidal?’)” to determine whether a detainee is suffering mental illness.

Drug abuse presented an equally thorny problem for many jails, said Kubiak. “Most jails have little therapy or protocols for inmates suffering withdrawals,” she said. “Some just hand out blankets and Gatorade and think that’s enough.”

The study also noted that, because of immense variation in organizational processes among the jails, some counties did a better job than others of identifying individuals with mental health issues and ensuring they were referred to and received a mental health service. One county, for instance, processed 148 individuals who were identified as suffering mental illness, and all 148 received referrals. Meanwhile, another county identified only seven such individuals, and only four received treatment referrals.

Furthermore, the study found that, across all jails, 47% of those booked into the facilities were charged with a “divertible” offense that could have had them placed into treatment in lieu of or in addition to jail time.
Also, the study looked at how jail-based diversion services affected offenders’ success in seeking treatment upon release from incarceration. The study found that 64% of those who received jail-based services entered into treatment programs after their release. Of those who did not receive jail-based services, only 31% engaged in treatment programs.

“As the study proves,” said Kubiak, “when we simply lock up mentally ill or addicted individuals with no real plan to get them help, we’re only prolonging and exacerbating problems that we have the tools to effectively address.”