Joint Study Committee on Treatment Options
for Offenders who have Mental Illness or
Substance Abuse Disorders (SJR 440)

Jail / Community Linkages

A Summary of Two Studies, Including:

Jail Diversion for Persons with Mental Illness:
The Sheriffs’ Perspective

and

Services for Persons with Mental Illness in Jail:
Implications for Family Involvement

Joseph Walsh
School of Social Work
Virginia Commonwealth University

Jail Diversion for Persons with Mental Illness:
The Sheriffs’ Perspective

Research Questions

Do sheriffs experience special problems in managing arrestees who have serious mental illness?

Do sheriffs perceive a need for additional diversion programs for persons with mental illness?

If so, what diversion programs do sheriffs recommend?

Research Methods

Questionnaire Topics:

87 Sheriffs targeted (those who provided direct law enforcement services to Virginia jails)

78 surveys were returned (89.6%)

69 were completed by a sheriff or deputy sheriff

6 were completed by a health professional working in the jail

3 were completed by administrative staff

Suggested Alternatives to Incarceration (N = 50)

Greater interaction between the mental health and court systems

A mental health professional assigned to every sheriff and magistrate’s office

Mandatory case management while the person is in jail

Greater continuity of care for persons with mental illness and substance abusers

Assertive follow-up of persons with mental illness after incarceration or diversion to prevent relapse, including after-hours availability

Sex offender programs in jail

A diversion center within the state psychiatric hospitals to assess clients

Guidelines for sheriffs about the nature of mental illness

Sheriff training in assessing mental illness versus substance abuse problems, including education about drug damage

Transitional and supervised housing for offenders, particularly those with histories of violent behaviors

Day treatment programs administered within community centers

More outpatient training in self-care skills

Day reporting requirements for offenders

Targeted work programs

Supervised community service work

More intensive pretrial evaluation

An increase in staffing for mental health services, including assessment

More cooperation from courts

A greater emphasis on family counseling

More consistent mandatory court-ordered treatment

Intensive probation program including mental health workers

In-home counseling

Medication monitoring

Supervised community placement while awaiting trial

An increase in drug rehabilitation programs

Why Alternatives to Incarceration are Not Needed (N = 19)

Existing programs (courts, jail, and probation) are adequate.

The arrestee must be held accountable for his or her behavior.

The arrestee just needs to stay on medication.

Persons with mental illness are repeat offenders even after receiving treatment.

These persons are too far-gone for new programs to be any help.

Additional Sheriff Comments

We need a better way to commit felons to hospitals, especially on weekends and holidays.

Dual-diagnosis clients (mental illness and substance abuse) are the most difficult.

Community services are not comprehensive enough.

We need community mental health programs featuring home visits for medication monitoring and meals provision.

Partnerships between the CSBs and sheriffs should focus on securing officer-protected transitional housing after jail discharge.

We need a closer working agreement with mental health centers.

Arrestees with mental illness are a labor-intensive group and we must work to preserve their safety and their threat to the safety of others.

We should re-evaluate criteria for involuntary commitment.

Most of these people can’t cope in jail - they wind up in isolation or are screened for hospitalization but do not meet the criteria.

Having a place to send them for treatment after discharge is important.

Informed judges, prosecutors, and attorneys are able to accelerate the judicial process at times.

Sheriffs need a greater awareness of what services might be available.

Inmates should be transferred from the jail immediately if they are mentally ill.

Rural communities have fewer options.

The hospital closings put more people in jails.

Conclusions

Virginia sheriffs routinely encounter people with mental illness in the course of their law enforcement work.

Slightly more than half of the sheriffs report special problems managing arrestees with mental illness. These problems tend to involve getting the person’s mental health needs met during or after incarceration, rather than jail management concerns.

Two-thirds of the respondents believe that the jail / mental health systems work pretty well, but almost three-fourths of them perceive a need for additional jail diversion programs.

Sheriffs have many suggestions for diversion programs or additional community services that may help reduce recidivism with these arrestees. Their suggestions are consistent with many of the recommendations offered by mental health professionals.

Services for Persons with Mental Illness in Jail:
Implications for Family Involvement

Purpose of the study: To determine ways in which families, with the assistance of mental health professionals, can ensure that persons with mental illness receive appropriate services and linkages during and after incarceration.

Research Methods

Questionnaire topics:

13-item questionnaire was sent to the "Mental Health Manager" of Virginia’s 93 jails

62 responses (67%)

43 respondents worked for the CSB

18 respondents were employed by the county jail or the state

Mental Health Services in Jails

59% of respondents indicated that they were unable to provide some aspects of mental health treatment at the jail.

34% reported comprehensive mental health treatment capabilities on site.

7% were uncertain or did not answer.

Four factors emerged regarding the issue of what treatments are unavailable to detainees with mental illness:

Jail environment problems (44%), such as:

Unmet special needs (39%), including:

Jail resource shortages (17%), including inadequate:

46% replied that their jail did not support family involvement.

44% replied that their jail was supportive of family involvement.

10% were uncertain or did not answer.

Respondents indicated that families could become more involved with the detainee in three ways:

Facility limitations, (73%), or shortages in space, staffing and service

Policy barriers (16%), including inflexible rules, procedures, and security concerns

Limitations in the family itself (11%), including an inability or unwillingness to get involved

What Families Need To Know To Ensure Adequate Treatment For The Detainee With Mental Illness

Families can have influence in the mental health treatment of the detainee. Direct advocacy may make a difference in the quality of care received by the detainee and in the accessibility of linkages at discharge.

Family members must have knowledge about the organization and staffing of the jail and related systems in order to effectively participate in planning for intervention.

When a relative is in jail, the most effective professional resource is likely to be found at the community services board.

The jails are unlikely to offer a greater range of services to persons with mental illness without organized advocacy efforts at the CSB and State Department levels.

JOINT COMMISSION ON BEHAVIORAL HEALTH CARE

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