Jail Diversion in North Carolina
February 2009
919 / 715-2771 or Bob.Kurtz@ncmail.net
“What county officials and the public should
know about the incarcerated mentally ill
population is not just that these individuals
will significantly benefit from a system of
comprehensive services, such as housing,
health, and human services, but that such a
strategy would be less expensive and more
effective in the long-term.”
- National Association of Counties Report
titled: Best practices for diverting mentally
ill individuals from county jails. - June 2003
Lack of services or
barriers to service will
increase the likelihood
that people with
mental illness
will end up in jail.
Penrose’s Law: There’s an inverse
relationship between Severe &
Persistent Mental Illness
incarcerated and those in hospitals
Psychiatric instability often results in
legal problems…...

About 20% of people with SMI who have been treated
and released from a psychiatric hospital are arrested
within one year of discharge - compared to 5% life
time arrest rate for the general population.
 Usually the arrest is for minor crimes…
 Trespassing
 Public Intoxication
 Disturbing the public order
 Impeding the flow of traffic
 Drug related offenses.
 According to a recent Duke University
study.
High Rates of People with
Serious Mental Illness in Jail
Every year, about 800,000 people with severe
mental illness are incarcerated in US jails.
 More than 16% of people in US jails have a
serious mental illness (compared to 5% in
general population).
 More than 4% of men in jail suffer from
Schizophrenia or Bipolar Disorder-manic phase
 Women in jail have almost double the rate of
serious mental illness as men.

People with mental illness don’t fare
well in the criminal justice system

Research shows that people with mental illness 
Are more likely to be arrested - In one study, 47% vs. 26% for nonMI following police encounters.

Face more serious charges - Are often charged with more serious
crimes than others for similar behavior.

Stiffer sentences - Are sentenced more severely than other people
with similar crimes.
People with mental illness in the
criminal justice system continued...
 Serve
longer in jail and prison - Spend two to five times
longer in jail and average 15 months more in prison.
 Can’t
make bail - Are often detained because they have
no income and can’t make bail.
 Have
more difficulty coping - Experience more fights,
infractions, and sanctions in prison
 Are
more vulnerable - To being exploited or manipulated
by other inmates.
In North Carolina jails…...*
 People
with mental illness are often not identified
when they enter jail:
 There is quick access to emergency mental health
care in jail, but limited access to hospital beds for
mentally ill jail detainees:
 Policies exist that violate mentally ill detainees’
rights / dignity:
 Medications are often changed to a cheaper
substitute in jail:
 Communication / linkage between jail and
community providers varies widely:
* Vaughn & Schyette, 2007, study of mentally ill in NC jails.
Requirements of H.B. 1493 - Section 10.49 (f)
“Within available resources….”
 A statewide standardized evidence-based screening
instrument shall be used when offenders are booked.
 LMEs and county sheriffs shall work together to develop all of
the following:
a. A designated LME employee who is responsible for
screening the daily jail booking log for known mental health
consumers.
b. Protocols for effective communication between the
LME and the jail staff including collaborative development of
medication management protocols between the jail staff and
the mental health providers.
c. Training to help detention officers recognize signals of
mental illness.
Goals of Jail Diversion Programs
Preventing the inappropriate
incarceration of persons with
mental illness and cooccurring disorders.
 Reducing jail time for people
with mental illness who are
inappropriately confined.
 Linking detainees to
appropriate mental health and
community services following
their release from jail.

Jail Diversion is not discharge
planning or in-jail treatment


Jail Diversion: Is a special program
designed to help people with mental illness
move from the criminal justice system to
appropriate treatment in the mental health
system.
 In contrast Discharge / Transition Planning: Is part
of the usual criminal justice process that
occurs when the offender would ordinarily
leave jail.
What do jail diversion staff do?

Screen - detainees in contact with the criminal
justice system for the presence of a mental illness.

Negotiate - with law enforcement, prosecutors,
defense attorneys, and the court to develop
community-based mental health treatment
dispositions for clients as alternatives to
incarceration.

Link - clients to community based mental health
services, once the mental health disposition is
determined and agreed on by all parties.
Two Categories Of
Jail Diversion Initiatives

Pre-booking - Provide community based
alternatives to arrest and incarceration. Most
include a 24 hour crisis unit with a no refusal
policy for law enforcement.

Post-booking - Following arrest and with the
agreement of the court, involvement in
treatment in the community.
When law enforcement responds to
calls on people with mental illness...
The arrest rate is 20% when no specialized
response exists.
 The arrest rate is 7% when some form of
specialized response exists.
 The arrest rate for the Memphis CIT
program is just 2%.

 Percent
of incidents resolved on scene = 23%
 Percent of incidents resulting in the person
being transported to a crisis unit = 75%
Comparisons of pre-booking models
Three models were examined to determine
the proportion of police “mental disturbance”
calls that resulted in a specialized response.
 The results….

 Birmingham
MH “imbedded” model - 28%
 Knoxville mobile crisis model - 40%
 Memphis CIT model - 95%

Steadman, H., et.al, Comparing outcomes of major models of
police responses to mental health emergencies. Psychiatric
Services, May 2000.
Awards / Recognition for
Wake’s CIT program
Program of Excellence 2006:
- NC Council of Community Programs
 Agent of Change Award 2006
- Easter Seals UCP / ASAP
 Outstanding County Program 2007
- NC Association of County Commissioners
 CIT is a “Ray of hope in the system”
- News & Observer article quoting Verla Insko State representative and chairwoman of the
House Committee on Mental Health Reform.

Mental Health Courts



Are evolving rapidly
As yet, no evidence based conclusions
Steadman* recommends
 A single court docket
 Courtroom team approach
 Specific plan manager
 Assurance of treatment slots
 Expanded services to avoid displacing others in need of
treatment (I.e., earmark services for the court so other
clients aren’t pushed out of service).

Hank Steadman, Ph.D., Director of Policy Research
Associates and the TAPA Center, providing technical
assistance to SAMHSA funded jail diversion programs.
What we’ve learned about mental
health courts……




Need to assure that there are expanded
numbers of intensive treatment slots for MH
Court clients.
Treatment that is court ordered needs to be
consistent with what could be accessed without
referral to the mental health court.
Referral to the mental health court should be
reserved for those consumers who need the
oversight of the court to remain compliant.
Should not exclude persons with mental illness
who have a committed a violent offense.
Where Diversion Can Occur
Arrest
Booking
Prevention
of Arrest
Diversion
Before
Booking
Probation
Jail or
Prison
Court
Diversion
Before
Adjudication
Mental
Health
Court
R
Violation of Rights
Cost Effectiveness of Intervention
The earlier the diversion is in the criminal justice process, the better!
Release and
planning to
return to
community
Continuum of jail diversion
services.
Interaction
with police
Jail
Court
Not
diverted
Pre-booking
diversion
(to crisis unit or other
community service)
Post-booking
diversion
Mental
health
court
Released to
community after
sentence is served
Core Conceptual Model
(Outcomes for jail diversion depend on a comprehensive mental health
service system, and clients being effectively linked to that system)
Jail Diversion
Comprehensive
Appropriate
treatment
Improved
Outcomes
Divert from jail to??????
“Successful jail diversion efforts require more
than simply diverting an individual with mental
illness away from jail. He or she must also be
diverted into appropriate and adequate
treatment services.”
Jail diversion requires a comprehensive,
responsible, & accountable mental health system!
“Poorly organized jail diversion programs lacking a
mental health infrastructure produce short-term
results that may harm the client and community.”
Integrated Treatment for People with
co-occurring mental illness and
substance abuse is particularly
important for Jail Diversion clients.

More than 72% of people with severe
mental illness who are in jail have a cooccurring substance abuse disorder.
Jail diversion programs
may benefit counties by….
Helping to alleviate jail over-crowding
 Reducing costs of incarceration and
unnecessary prosecution
 Helping consumers get access to
appropriate services
 Providing support and incentives for staying
in treatment
 Helping end the cycle of repeated
incarcerations and crisis care

CIT in North Carolina – February 2009
Alleghany
Camden
Northampton
Currituck
Gates
Stokes RockinghamCaswellPerson
VanceWarren
Pasquotank
Hertford
Granville
Halifax
Watauga Wilkes
Perquimans
Yadkin
Forsyth Guilford
Orange
Mitchell
Avery
Chowan
Alamance Durham
Franklin
Bertie
Alexander
Nash
Caldwell
Davie
Yancey
Madison
Edgecombe
Washington
Iredell
Wake
Martin
Burke
Davidson
Tyrrell Dare
Wilson
Randolph Chatham
Catawba
Rowan
Buncombe McDowell
Beaufort
Pitt
Haywood
Johnston
Hyde
Lincoln
Greene
Swain
Rutherford
Montgomery
Cabarrus
Lee
Henderson
Harnett
Graham
Wayne
Gaston
Jackson
Polk
Stanly
Lenoir
Moore
Craven
Cleveland
Mecklenburg
Cherokee
Transylvania
Macon
Cumberland
Pamlico
Richmond
Clay
Jones
Union
Anson
Sampson Duplin
Hoke
Onslow
Scotland
Carteret
Ashe
Surry
Robeson
Bladen
Pender
NC counties where CIT
trainings have been held.
Columbus
New
Hanover
Brunswick
Post-booking Jail Diversion
In North Carolina by 2009
Alleghany
Ashe
Watauga Wilkes
Caldwell Alexander
Madison Yancey
Stokes RockinghamCaswellPerson
VanceWarren
Granville
YadkinForsyth
Mitchell
Avery
Burke
Camden
Northampton
Surry
Orange
GuilfordAlamance
Durham
Davie
Iredell
Davidson
Randolph Chatham
Catawba
Rowan
Gates
Hertford
Halifax
Franklin
Nash
Edgecombe
Martin
Pasquotank
Perquimans
Chowan
Bertie
Wake
Washington
Tyrrell Dare
Wilson
Buncombe McDowell
Beaufort
Pitt
Haywood
Johnston
Lincoln
Greene
Swain
Rutherford
Montgomery
Cabarrus
Lee
Henderson
Harnett
Graham
Wayne
Gaston
Jackson
Polk
Stanly
Lenoir
Moore
Craven
Cleveland
Mecklenburg
Cherokee
Transylvania
Macon
Cumberland
Pamlico
Richmond
Clay
Jones
Union
Anson
Sampson Duplin
Hoke
Onslow
Scotland
Robeson
Carteret
Bladen
Pender
Intensive Case Mgt
Columbus
New
Hanover
Brunswick
Mental Health Court
Currituck
Hyde
North Carolina Jail Diversion Data
 Estimates
by case managers in five jail
diversion programs indicated an average
of 3,174 jail days reduced per year per
jail diversion program.
 These data suggest an average of 8.7
fewer inmates in jail per year in those
areas where jail diversion programs
exist.
Outcome data on clients in
North Carolina jail diversion programs for
one year show…






Higher global assessment of functioning scores.
Report lower rates of substance abuse.
Lower rates of homelessness.
Greater satisfaction with housing.
Movement to more independent housing.
Higher rates of employment.

But rates of re-arrest and psychiatric hospitalization and inpt treatment
for substance abuse were not reduced during that first year.
Collaboration
between Mental Health &
Justice Systems is complicated by their
differences
Different Interests




Mental Health Providers: Concerned
with client’s emotional and psychiatric
well being.
Jail: Concerned with safety. Group vs.
Individual focus.
Defense Attorney: Often concerned with
short term legal (instead of long term
“best”) interests of client.
Judges: Concerned with community
safety.
Different Constituencies


Police----------------------Prosecutor----------------Defense Attorney-------Judge----------------------Sheriff----------------------

Mental Health staff------





Actor






Constituency
Local Community
Government
Defendant
The Law (and electorate)
The wider community and
sometimes federal judge
The client, family,
advocates, local community,
and state.
DIFFERENT LANGUAGE
-including different definitions of diversion*
Justice system definition of diversion: To divert the
criminal case out of the justice system and off the court
docket. Judge’s may view this type of diversion as a
criminal’s attempt to “get out of jail free.”
Mental health system definition of diversion: To divert
the client from jail to the community mental health system.
Deferred prosecution, continued court oversight, and
(perhaps) mandatory treatment are included in this definition.
*To a judge, deferred prosecution is not diversion.
“
The most effective way to improve
your relationship with the justice
system is to increase your
understanding of it.”




Learn the “language” of the justice
system
Know how the justice system functions
in your community
Understand the culture of your law
enforcement officers and jails.
Beware of the many challenges faced
by those working in the justice system.
The Benefits of Working Together






Reduce jail days, reduces overcrowding, reduces
overcrowded court dockets.
Reduces jail service expenses.
Reconnects people to services.
Coordinates services - reduces waste.
Gives people structure, allowing them to focus on
recovery.
Increases Federal share of treatment cost.
For More Information about Jail Diversion




The Tapa Center is the organization contracted by SAMSHA to
provide technical assistance to jail diversion programs. Contact
them at: www.tapacenter.org or (866) 518-8272
The GAINS Center is a national organization that collects and
disseminates information about effective services for people
with co-occurring disorders in contact with the justice system.
Access them at: www.gainsctr.com
The Consensus Project is an national effort to provide
information, research and support to organizations attempting
to help people with mental illness in the criminal justice system.
It is sponsored by the Council of State Governments. They
may be reached and their report downloaded at:
www.consensusproject.org
Or Bob.Kurtz@ncmail.net or 919 / 715-2771