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Articles   |    
Mental Health and Reoffending Outcomes of Jail Diversion Participants With a Brief Incarceration After Arraignment
Allison G. Robertson, Ph.D., M.P.H.; Hsiu-Ju Lin, Ph.D.; Linda K. Frisman, Ph.D.; John Petrila, J.D., LL.M.; Marvin S. Swartz, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300286
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Dr. Robertson and Dr. Swartz are with the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina (e-mail: allison.gilbert@duke.edu). Dr. Lin and Dr. Frisman are with the Connecticut Department of Mental Health and Addiction Services, Hartford. Mr. Petrila is with the Department of Health Policy and Management, University of South Florida, Tampa.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Jail diversion programs strive to divert offenders with mental illness from prosecution and into mental health treatment. Participants sometimes spend a short time in jail after arraignment, either because treatment resources are not immediately available or because judges want to increase their motivation for treatment. This study explored the effects of short jail stays before jail diversion (“jail first”) on participants’ postdiversion service use and reoffending.

Methods  The data were merged administrative records from public behavioral health and criminal justice systems in Connecticut for 712 adults with serious mental illness who participated in the jail diversion program during fiscal years 2005–2007. The effects on treatment receipt, crisis-driven service use, and reoffending during the six months postdiversion among jail first participants (N=102) versus a propensity-matched sample of participants who were diverted immediately (N=102) were estimated.

Results  Jail first participants had greater improvements in receipt of psychotropic medication during the follow-up compared with their counterparts who were diverted immediately. However, compared with participants who were immediately diverted, they did not have greater reductions in crisis-driven service use or reoffending and the time to reincarceration was shorter.

Conclusions  Short stays in jail before diversion did not appear to be associated with improved mental health and reoffending outcomes, even though they appeared to improve receipt of psychotropic medication. Further research is needed to better understand the relationships between jail first, receipt of psychotropic medication, and broader health and offending outcomes, with a focus on identifying missing links that address criminogenic risks and participants’ more intensive social service needs.

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Table 1Characteristics of jail first and immediately diverted participants of a jail diversion program before and after propensity matchinga
Table Footer Note

a Jail first participants were briefly incarcerated before diversion.

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b Use of services or criminal justice contacts in the three months before diversion. DMHAS, Department of Mental Health and Addiction Services

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*p<.05, **p<.01

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Table 2Postdiversion outcomes among jail first and immediately diverted participants of a jail diversion programa
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a Jail first participants were briefly incarcerated before diversion. Outcomes are reported for a six-month follow-up period following diversion.

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Table 3Receipt of psychotropic medication and mental health outpatient services after diversion among jail first versus immediately diverted participants of a jail diversion programa
Table Footer Note

a Jail first participants were briefly incarcerated before diversion. Use was measured over a six-month follow-up period. The results represent predictions based on mixed-effects, mixed-distribution models that adjusted for postdiversion periods of incarceration. Receipt of psychotropic medication was estimated by using a medication possession ratio (MPR), the proportion of days in a month in which an individual has a supply of psychotropic medication appropriate for his or her primary psychiatric diagnosis. Level of medication receipt was a continuous measure of MPR. Count of services was the number of core outpatient mental health or substance abuse services either paid by Medicaid or paid and provided by the Connecticut Department of Mental Health and Addiction Services (DMHAS). Each study group consisted of 102 participants, for a total of 1,428 person-months.

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*p≤.05, **p≤.01, ***p≤.001

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Table 4Incarceration and hospitalization after diversion among jail first versus immediately diverted participants of a jail diversion programa
Table Footer Note

a Jail first participants were briefly incarcerated before diversion. Use was measured over a six-month follow-up period. The results represent predictions based on mixed-effects, mixed-distribution models that adjusted for postdiversion periods of incarceration. Each study group consisted of 102 participants, for a total of 1,428 person-months.

Table Footer Note

b Includes only hospitalizations in Connecticut Department of Mental Health and Addiction Services psychiatric hospitals

Table Footer Note

*p≤.05, **p≤.01, ***p≤.001

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Table 5Predictors of time to incarceration and psychiatric hospitalization among jail first versus immediately diverted participants of a jail diversion programa
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a Jail first participants were briefly incarcerated before diversion. Cox proportional hazard models were used to estimate differences between study groups in time to incarceration and psychiatric hospitalization during a six-month follow-up period. HR, hazard ratio

Table Footer Note

b Includes only hospitalizations in Connecticut Department of Mental Health and Addiction Services (DMHAS) psychiatric hospitals

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