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Taking Issue   |    
Donut Shop Diversion Program
Jeffrey L. Geller, M.D., M.P.H.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.12.1559
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The objective of jail diversion programs and mental health courts is a worthy one: to facilitate interventions for persons with mental illness in the mental health system rather than perpetuate the nonproductive pattern of arrest-custody-release in the criminal justice system. It is a blot on the public system of psychiatric treatment that jails, such as the Los Angeles County Jail and Riker's Island in New York City, are among the nation's largest "inpatient psychiatric facilities."

Although few would argue with the premise that mental health treatment is better than incarceration for persons who have illnesses that require—and generally respond to—treatment, some have objected to the fact that the system rests on largely on coercion. However, individuals are given an apparent choice—treatment or jail—and the ends may justify the means in applying this "tincture of coercion."

Still, we must consider whether we are further stigmatizing persons with mental illnesses by selecting them for jail diversion programs. What about other potential beneficiaries of coercive interventions—for example, persons with obesity? They have a serious medical condition, and the costs to treat coronary artery disease, diabetes mellitus and its sequelae, and orthopedic conditions are high. Obesity has societal implications far beyond the health of an individual.

How about a donut shop diversion program? In front of every donut shop, we station a policeman. Anyone who looks 30 percent or more over his or her ideal body weight is asked to step on a scale. Those who are over the weight threshold are given a choice—a weight reduction clinic or jail. They could be charged with one or more of the nuisance crimes, but it would become assault and battery on a police officer if the donut seeker got out of hand. By this means, we would reduce obesity, decrease health care costs, save hospital beds, and improve the quality of life of the overweight citizenry.

"Nonsense!" you say. "People who eat donuts choose to do so; they make an informed decision. People with mental illness are not making rational choices."

But many persons with chronic mental illness are capable of giving informed consent. And many overweight people say to themselves in the donut shop parking lot, "I shouldn't go in there," and then march right in. Do they have "free choice"? Is obesity always voluntary?

Jail diversion is a worthy endeavor. It should be pursued with cautious optimism, but it should not become another process that isolates or stigmatizes people with mental illness. The criminal justice system should be used to help mainstream those with mental illness, not spotlight their differences.

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