Topic: Frequent Jail Users

If they go to jail at all, most people in America only do so once. But in communities across the country, there is often a small group of people who account for a large number of jail admissions. They also account for a large portion of total jail expenditures. A new two-year research project sought to better understand this population in three communities and makes policy recommendations from which others can learn. The John D. and Catherine T. MacArthur Foundation funded the study as part of their Safety and Justice Challenge, which seeks to reduce jail populations.

How Did the Researchers Work and What Did They Find?

The study incorporated quantitative and qualitative methods. Researchers drilled into at least eight years’-worth of data from each of three communities to identify and describe the population of people with frequent jail contact. They also conducted interviews with 27 practitioners across a range of service sectors and 23 people with lived experience. Finally, they used both the quantitative and qualitative data to examine the strategies used by each community participating in the study to reduce jail contact.

The research found people with frequent bookings accounted for about one-half of all the bookings that occurred during the study period. Across communities participating in the study, people with frequent jail contact account for a majority of bookings, but account for a minority of the people booked. People of color and people with behavioral health needs are overrepresented. The study’s findings also emphasize complex interrelationships between race and ethnicity, gender, and behavioral health needs. They point to potential disconnects between the perceived and actual characteristics of people with frequent jail contact.

Different communities used different strategies to aid people with frequent jail contact but most did not have strategies intended for that exclusive purpose. Rather, they implemented strategies intended to aid everyone. All participating communities selected diversion strategies for people with behavioral health conditions as their primary intervention for the study’s focus. And the study found that behavioral health diversion strategies may improve outcomes for people with frequent jail contact. More broadly, the study findings underscore the importance of comprehensive community-based resources to support the success of behavioral health diversion programs. Findings also show the need for strategies that cross many systems and levels of policy and practice.

Policy Recommendations

Based upon the study findings, the researchers have nine policy recommendations:

1. Create a Data Sharing Ecosystem

To meet the complex needs of people with frequent jail contact—especially individuals with behavioral health challenges—criminal legal and behavioral health systems need a common data sharing language and platform. Ideally, the common language and platform would extend to other systems as well, such as social and emergency services.

2. Establish Formal, Jurisdiction-Specific Definitions

Jurisdictions should develop formal definitions or criteria to support the consistent operationalization and identification of people with frequent jail contact. These definitions should drive the development and implementation of related policies.

3. Use Validated Behavioral Health Screening Tools

Consistent with the standards for health services in jails and prisons, universal screening using validated screening tools should take place during the intake process at each door into and away from the criminal legal system.

4. Implement Psychiatric Advanced Directives

Psychiatric advance directives are intended to enable self-determined treatment, and effective and clear communication from a past and competent self, for individuals who are at risk of losing decisional capacity at some point in the future.

5. Facilitate Jail In-Reach Programs

Trust and engagement are key to successful reentry for people with frequent jail contact. Jail in-reach programs allow practitioners to meet with people in the jail before release, assess their needs when back in the community, develop a plan to meet those needs, identify how community providers can assist, and provide coordinated support as people transition into the community.

6. Increase Peer Support Programs

Peer support programs should be a key feature of policies designed to reduce frequent jail contact. While the focus is typically on lived experience with behavioral health systems, people with lived experience of the criminal legal system, specifically, share a common understanding of the challenges and resources necessary for successful reentry.

7. Improve Access to Housing

Affordable housing is scarce in most communities. Providing safe, sustainable, and supportive housing for people involved in the criminal legal system with behavioral health conditions can be a challenge, but it is critical to reducing frequent jail contact.

8. Increase Utilization of Community-Based Services

When possible, people should be given the necessary supports in navigating the continuum of care. In addition to warm handoffs from one service provider or program to another, other examples include a shared video chat with a new provider or engaging peer support services during transitions.

9. Center and Evaluate Efforts for Racial Equity 

Evaluations suggest that efforts to reduce frequent jail contact have had limited success in improving racial equity in this population, likely due to multiple, intersecting factors. Communities should work to mitigate systemic racism through the operations of their criminal legal and behavioral health services for people with frequent jail contact and examine the success of these efforts through formal evaluations.

For years we have witnessed an increase in the number law enforcement interactions with individuals in the community with unaddressed behavioral health challenges. Conversely, there remain far too few alternatives to unnecessary arrest or transport to the emergency department.

Middlesex County, in Eastern Massachusetts, is New England’s most populous county. Our criminal justice and behavioral health leaders recognized the need improve capacity and access to behavioral healthcare in the community. In 2018, the Massachusetts legislature created the Middlesex County Restoration Center Commission to develop a pilot that would help solve the “divert-to-what?” question. In Middlesex County, the sheriff’s office offers evidence-based programing and treatment for incarcerated individuals, but individuals should not have to go to jail to receive the services they need.

We are grateful to have recently been invited to join the Safety and Justice Challenge’s new IMPACT behavioral health cohort, to share some of the lessons we have learned, and learn from our partner jurisdictions in this impressive network. The Commission has just entered its fourth year of work, and our path forward will be made easier through this tremendous peer exchange opportunity.

One of the biggest lessons we have learned, and hope to pass along to our partner jurisdictions, is the importance of improving collaboration and communication across siloed fields like public safety and behavioral health. All too often, addressing behavioral health needs of the community remains in traditional agency siloes. From the sheriff’s office to mental health service providers and police departments to peer and advocacy organizations, it is only this kind of collaboration that is able to stop people from falling through the cracks.

Middlesex County has 1.6 million people with 54 different police departments spread across urban, suburban, and rural areas. We are fortunate to have the progressive leadership of our police chiefs focused on diverting individuals away from the criminal justice system and into treatment. Similarly, we are fortunate to have a health and human services community poised to step up to increase outreach and engagement, to partner with public safety, and to provide appropriate assessment, treatment, stabilization, and support services to affected individuals.

In an effort to shift the responsibility back to the behavioral health community, we knew it was necessary to develop a model that knit together services in a way that made them easily accessible to both the public and local law enforcement. We wanted to move away from the traditional model of stabilization and release from the emergency department. The Restoration Center will offer both stabilization as well as a comprehensive assessment to inform referral to treatment so the needs of individuals can be appropriately met. Our goal is not only to stop the cycle of unnecessary incarceration but also to help individuals stay healthy enough that they do not have to return to the center.

After years of planning and implementation our goal is to launch a pilot Restoration Center in 2022. We believe we are well positioned to launch the model we have developed in large part due to our commitment to the cross-sector planning process which started with identifying gaps in the delivery of behavioral healthcare, a cost-benefit analysis, and interviews with individuals with lived experience. Through our state legislature, we were successful in securing initial funding as well as a trust fund that will allow the Commission to accept third-party funding.

Now that the Commission’s 2022 budget includes $1 million in funding for the pilot – endorsed by a recent editorial in the Boston Globe, we can begin our work of identifying a provider. We continue to pursue additional funding to ensure that we can implement a full range of services identified as critical to the success of individuals who might otherwise be arrested or hospitalized.

The center will provide behavioral health services to individuals in mental health or substance use crisis. These services will help support ongoing law enforcement efforts across the county to divert individuals with behavioral health conditions from arrest or unnecessary hospitalization.

Local law enforcement and corrections have shouldered this burden for far too long, with over 70 percent of people in our Middlesex Jail & House of Correction having an open mental health case and 80 percent have a history of substance use.  Each and every one of these individuals receives treatment while incarcerated, but these are services that people should be able to access in the community. Our hope is that the Restoration Center will help stop the cycle of unnecessary incarceration.

We attribute a lot of the success of the Middlesex County Restoration Center Commission to the commitment of our diverse stakeholder group. It is not common to have a sheriff co-chair a legislative commission with the president of a mental health advocacy group. It is also unusual to get representatives of the 80 largest behavioral health providers at the county, police chiefs, the chief administrative justice of the trial court, and key state legislators at that table. And sustaining the focus on a challenging goal for over three years is the rarest thing of all. But that is what it takes.

Unfortunately, political will is often the hardest thing to secure. But we owe it to the people falling through the cracks to get it right.