Excessive incarceration of individuals with mental health and substance use disorders: Jail diversion programs may be the answer

The number of individuals with mental illness and substance use disorders in U.S. jails and prisons is troubling, with estimates ranging from 360,0001 to more than a million.2 At least 30 percent of incarcerated adults have a serious mental illness, and approximately 65 percent have a substance use disorder. Twenty-five percent have both.3

Now, an alarming statistic from Human Rights Watch (HRW) asserts that U.S. jails and prisons house three times as many individuals with mental health problems as do state mental hospitals.4 According to the HRW report, U.S jails and prisons have, in effect, taken on the role of mental health facilities.4,5 The group attributes this new role, to a great extent, to “the limited availability of community-based outpatient and residential mental health programs and resources, and the lack of alternatives to incarceration for men and women with mental disabilities who have engaged in minor offense. The group calls for replacing incarceration with community-based jail diversion programs.4

OptumTM has seen the benefit of such programs for many years. Salt Lake County, Utah, provides a full range of crisis services — including mobile crisis outreach teams and a receiving center for timely and supportive interventions. County law enforcement leverages these services to great effect. According to Salt Lake County, if even half of the referrals made by law enforcement between July 1, 2013, and June 30, 2014, prevented booking and jailing, these two crisis services alone would have saved the county over $650,000.

In FY 2011, state spending on correctional health care totaled $7.7 billion, about a fifth of overall prison expenditures.6 The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes crisis services as a key component of any system of behavioral health care and a key factor in reducing unnecessary costs and improving health outcomes.7 From both a humanitarian and a financial perspective, jail diversion programs are worth exploring.

To learn more about alternatives to incarceration, read “Jail diversion programs — a lower cost, higher impact alternative for offenders with mental health or substance use disorders.

–Rick Elorreaga

About the author

Rick Elorreaga is executive director for Optum Salt Lake County operations.

  1. Torrey EF, Zdanowicz MT, Kennard AD et al. The treatment of persons with mental illness in prisons and jails: A state survey. Treatment Advocacy Center, April 8, 2014. http://www.treatmentadvocacycenter.org/problem/consequences-of-non-treatment/2580; accessed July 31, 2015.
  2. James, DJ and Glaze LE. Mental Health Problems of Prison and Jail Inmates. Bureau of Justice Statistics Special Report, U.S. Department of Justice, Office of Justice Programs, September 2006, NCJ 213600, revised 12/14/06. http://bjs.gov/content/pub/pdf/mhppji.pdf; accessed July 31, 2015.
  3. Schiff M. Examining state prison health care spending: Cost drivers and policy approaches. Health Affairs Blog, November 2014. http://healthaffairs.org/blog/2014/11/04/examining-state-prison-health-care-spending-cost-drivers-and-policy-approaches/; accessed July 31, 2015.
  4. Callous and Cruel: Use of Force against Inmates with Mental Disabilities in US Jails and Prisons, Human Rights Watch, May 12, 2015. https://www.hrw.org/report/2015/05/12/callous-and-cruel/use-force-against-inmates-mental-disabilities-us-jails-and; accessed July 31, 2015.
  5. Torrey EF, et al. More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States. Treatment Advocacy Center, May 2010. http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf; accessed July 31, 2015.
  6. Report: State Health Care Spending. The PEW Charitable Trusts, July 8, 2014. http://www.pewtrusts.org/en/research-and-analysis/reports/2014/07/08/state-prison-health-care-spending; accessed July 31, 2015.
  7. Justification of Estimates for Appropriations Committees, Fiscal Year 2016, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, p. iii. http://www.samhsa.gov/sites/default/files/samhsa-fy2016-congressional-justification_2.pdf; accessed July 31, 2015.

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