Pre‐arrest diversion of people with mental illness: literature review and international survey

Abstract

Mental health diversion is a process where alternatives to criminal sanctions are made available to persons with mental illness (PMI) who have come into contact with the law. One form of mental health diversion is pre-arrest, in which the police use their discretion in laying charges. Concomitant with the growth of pre-arrest diversion programs is a growing body of research devoted to the phenomenon. The purpose of this paper is to review the existing literature of pre-arrest diversion, and to report the results of an international survey of pre-arrest diversion programs we conducted to identify evidence-based practices. On the basis of our review and survey, we note that successful pre-trial programs appear to integrate relevant mental health, substance abuse and criminal justice agencies by having regular meetings between key personnel from the various agencies. Often, a liaison person with a mandate to effect strong leadership plays a key role in the coordination of various agencies. Streamlining services through the creation of an emergency drop-off center with a no-refusal policy for police cases is seen as crucial. While there is some indication that mentally ill offenders benefit from their participation in this form of diversion, the evaluative literature has not yet achieved the "critical mass" necessary to create generalizable, evidence-based knowledge. The absence of generally agreed-upon outcomes could lead to the inequitable application of basic principles of diversion. We suggest that indicators, benchmarks, and outcomes must be agreed upon if a comprehensive understanding of pre-arrest programs is to emerge.

Communicating about Mental Illness and Violence: Balancing Stigma and Increased Support for Services

“…by requiring adherence to a mental health treatment plan as an alternative to serving a prison sentence (Goodale, Callahan et al 2013). Crisis interventions teams are teams of law enforcement officers, sometimes paired with mental health professionals, who have completed training on the symptoms of mental illness, mental health treatment, and de-escalation techniques (Hartford, Carey et al 2006, Watson and Fulambarker 2012). These teams are responsible for responding to law enforcement calls involving individuals with SMI, with the goal of preventing violent encounters with law enforcement caused by psychiatric symptoms such as hallucinations or delusions.…”

“…These teams are responsible for responding to law enforcement calls involving individuals with SMI, with the goal of preventing violent encounters with law enforcement caused by psychiatric symptoms such as hallucinations or delusions. Some teams coordinate with mental health clinics or psychiatric crisis response teams in order to further divert individuals with SMI away from criminal justice involvement and into treatment (Hartford, Carey et al 2006, Watson and Fulambarker 2012, Kennedy-Hendricks, HA et al 2016). …”

Police Departments' Response in Dealing with Persons With Mental Illness

“…This model is the most popular of the alternative models (Hartford et al, 2006). Officers who volunteer to participate in the program receive 40 hr of training in mental health issues, substance abuse, and legal issues.…”

“…Officers are dispatched to mental health disturbance calls and respond alongside mental health professionals. Both the officers and mental health professionals decide on the appropriate course of action (Hartford, Carey, & Mendonca, 2006).…”

A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States

“…A literature review of prebooking diversion programs for people with mental illness identified specific program elements that improve processes and outcomes: ongoing interagency coordination between law enforcement and behavioral health, a single liaison person, and an emergency drop-off center (49). For people with low-level drug offenses, prebooking diversion models have only recently begun to develop in the United States; evidence from the first program site, in Seattle, indicates effectiveness for reducing recidivism (26).…”