CLINICAL HANDBOOK OF SCHIZOPHRENIA

Plan50. Jail Diversion 529The goal of transition planning is to address both the detainee’s short- and long-termneeds. To this end, special consideration must be given to the critical period immediatelyfollowing release to the community—the first hour, day, and week after leaving jail. Howwill the person’s basic needs for food, shelter, and clothing be met outside the jail? In addition,a major problem that can arise when a person is released from jail is disruption inthe supply of psychotropic medications started in jail. Good practice calls for providing asufficient amount of medication to last at least until the person can be seen for a followupappointment in the community.IdentifyAt this stage, the challenge is to identify specific community referrals that are appropriateto each releasee based on the underlying clinical diagnosis, cultural and demographic factors,financial arrangements, geographic location, and the person’s legal circumstances.The goal is to ensure that treatment and supportive services match the person’s level ofdisability, motivation for change, and availability of community resources. It is also importantto negotiate with the court and probation officer, so that the conditions of releaseand community supervision match the severity of the person’s criminal behavior. Anotherimportant consideration is to address the community treatment provider’s role (with regardto limits of confidentiality) vis-à-vis other social service, parole, and probation agencies,and the court system.CoordinateThe APIC model sensitizes clinicians to the complex, multiple needs that detainees withsevere mental illness often have, and to the use of case managers who coordinate multiplesources of community care and help the detainee span the jail–community boundary followingrelease. Other considerations at this stage are confirming that the releasee knowsthe details about follow-up appointments and has identified contact persons in the communityfor tracking purposes if aftercare appointments are not kept.PERTINENT RESEARCH FINDINGSIs jail diversion effective? The answer to this question depends upon whether criminaljustice or mental health outcomes are used as the standard of evidence. Current researchsuggests that for people with severe mental illness compared to nondiverted individuals,jail diversion does lead to more time in the community (i.e., fewer days in jail). However,individuals who are diverted do not have more favorable mental health outcomes (reducedsymptoms, improved functioning, etc.) than those who are not diverted. The mostcomprehensive effort to address these issues was the 5-year (1997–2002) multisite demonstrationstudy funded by the Substance Abuse and Mental Health Services Administration(SAMHSA), as described below.The SAMHSA study used a quasi-experimental, nonequivalent comparison groupdesign to examine the public health and public safety outcomes of three prebookingdiversion programs in Oregon, Pennsylvania, and Tennessee, and three postbooking diversionprograms in Arizona, Connecticut, and Oregon (Broner, Lattimore, Cowell, &Schlenger, 2004). Research staff interviewed participants at baseline, at 3 months, and at