CLINICAL HANDBOOK OF SCHIZOPHRENIA

532 VII. POLICY, LEGAL, AND SOCIAL ISSUESKEY POINTS• Diversion of detainees with severe mental illness is essential given that the goal of in-jailmental health services is to focus on assessment, crisis stabilization, and diversion—not onlong-term treatment.• Jail diversion can occur at the front door (prebooking) or the back door (postbooking) of thejail, and there are a number of sequential intercept points in both areas where persons withsevere mental illness can be diverted from criminal justice processing.• Partnerships between mental health clinicians and criminal justice authorities are essentialfor a workable diversion program.• Current research evidence suggests that jail diversion is more successful in reducing jailtime and lowering criminal justice system costs; however, jail diversion may increase mentalhealth treatment costs, and these increases appear higher than the criminal justice savingsassociated with jail diversion.• Many jail detainees with severe mental illness also have co-occurring substance abuse disorders,poor functioning, and long histories of repeated incarcerations and hospitalizations;the intensity of the services provided to these individuals must be calibrated to their needs.• Further research is needed to determine whether diversion to intensive, evidence-basedservices such as assertive community treatment or dual-diagnosis treatment teams wouldsignificantly improve both mental health and criminal justice system outcomes for jail detaineeswith severe mental illness.• Further research aimed at establishing the cost-effectiveness of calibrated interventionscan go a long way toward sustaining diversion efforts and improving community living opportunitiesfor thousands of persons with mental illness who cycle in and out of the criminaljustice system.REFERENCES AND RECOMMENDED READINGSBorum, R., Deane, M., Steadman, H., & Morrissey, J. (1998). Police perspective on responding tomentally ill people in crisis: Perceptions of program effectiveness. Behavioral Sciences and theLaw, 16, 393–405.Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. (2004). Effects of diversion on adults withco-occuring mental illness and substance use: Outcomes from a national multi-site study. BehavioralSciences and the Law, 22, 1–23.Harrison, P., & Beck, A. (2005). Prison and jail inmates at midyear 2004. Washington, DC: Bureau ofJustice Statistics, U.S. Department of Justice Office of Justice Programs.Massaro, J. (2004). Working with people with mental illness involved in the criminal justice system:What mental health service providers need to know. Delmar, NY: National GAINS Technical Assistanceand Policy Analysis Center for Jail Diversion.Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalizationof people with serious mental illness. Psychiatric Services, 57(4), 544–549.Osher, F., Steadman, H. J., & Barr, H. (2003). A best practice approach to community reentry fromjails for inmates with co-occurring disorders: The APIC model. Crime and Delinquency, 49(1),79–96.Reuland, M., & Cheney, J. (2005). Enhancing success of police-based diversion programs for peoplewith mental illness. Delmar, NY: GAINS Technical Assistance and Policy Analysis Center for JailDiversion.Steadman, H. J., Deane, M. W., Morrissey, J. P., Westcott, M. L., Salasin, S., & Shapiro, S. (1999). ASAMHSA research initiative assessing the effectiveness of jail diversion programs for mentally illpersons. Psychiatric Services, 50(12), 1620–1623.Steadman, H. J., McCarty, D. W., & Morrissey, J. P. (1989). The mentally ill in jail: Planning for essentialservices. New York: Guilford Press.Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for personswith serious mental illness and co-occurring substance use disorders. Behavioral Sciencesand the Law, 23, 163–170.