February 25, 2008

RALEIGH – North Carolina counties could boost public safety, cut costs, and improve health outcomes by steering the mentally ill away from jail and toward community-based care. That’s the major finding in a new John Locke Foundation Spotlight report.

Click here to view and here to listen to Joseph Coletti discussing this Spotlight report.

The report emphasizes successful models for jail diversion, including a program called the sequential intercept model. “It costs money to get the system right, but saves money overall while improving public safety,” said report author Joseph Coletti, JLF Fiscal and Health Care Policy Analyst. “One of every 10 police encounters involves a mentally ill person. Diverting them to effective treatment makes sense for everyone.”

The state’s mental health system generates much confusion, Coletti said. “Services are fragmented, and funding is not integrated,” he said. “The system is difficult for anyone to navigate, but it is a particular burden for those with the most chronic and severe mental illness. As a result, these individuals end up rotating through the most expensive locations for mental health care — emergency rooms, state hospitals, and the criminal justice system.”

Sixteen percent of all jail and prison inmates have serious mental illness, Coletti said. “That means among the 17,171 inmates in North Carolina as of June 30, 2005, it’s likely that about 2,750 of them had serious mental illness. Jails and prisons are not intended to provide the mental health treatment those inmates need.”

Care offered to inmates is designed to help them function well enough to stand trial or return to jail or prison, Coletti said. “Because of behavioral problems that arise without proper treatment, inmates with serious mental illness are held nearly six months longer than the average inmates before trial and are three times as likely to serve the maximum prison sentence if convicted. Mentally ill inmates are also more likely to come back into the criminal justice system after their release.”

In an ideal world, mentally ill people receiving proper community-based care would have no more contact with police than the physically ill, Coletti said. “In the real world, the best we can hope is to identify the mentally ill as early in the criminal justice process as possible and direct them into effective treatment programs,” he said. “Various jail diversion methods have been shown to reduce costs over time while keeping the public safe and increasing safety for the mentally ill and for police.”

Decreasing jail operation costs offset much of the initial increase in mental health costs, Coletti said. “The savings become substantial in later years on both the mental health and jail sides as patients rely less on hospitals and other costly forms of treatment.”

Ideas such as the sequential intercept model recognize the importance of identifying a mentally ill person early in his interaction with the criminal justice system, Coletti said. “This applies to other methods of jail diversion as well,” he said. “Crisis intervention teams like the one developed in Wake County allow communities to work with the mentally ill at the earliest stages. A viable pre-booking diversion system can help a community to avoid overwhelming its court system.”

If a mentally ill person must go to jail, he still can avoid unnecessary problems that can threaten safety and raise treatment costs, Coletti said. “Each jail should have a good working relationship with the agency or group — called a local management entity, or LME — that directs mental health care locally,” he said. “Some counties also have opted for mental health courts. Others might want to emulate a Memphis, Tenn.-area program called the Jericho Project, in which a public defender and social worker develop treatment alternatives for some mentally ill defendants.”

With overall savings and better outcomes from jail diversion, it’s clear counties should play a larger role in funding mental health services, Coletti said. “The current system’s reliance on Medicaid funding makes it hard to hold providers and case managers accountable for results within jails or at the LME level.”

“Counties have a direct stake in providing lower cost, community-based alternatives to prisons for mentally ill individuals,” he added. “Putting those alternatives in place will take time and creativity, but the effort will pay off in multiple ways.”

Joseph Coletti’s Spotlight report, “Jail Diversion Programs: A step toward better mental health reform,” is available at the JLF web site. For more information, please contact Coletti at (919) 828-3876 or [email protected]. To arrange an interview, contact Mitch Kokai at (919) 306-8736 or [email protected].