Issue Brief

Frequent Jail Users Frequent Utilizers Human Toll of Jail Jail Populations Mental Health July 25, 2023

Recommendations To Reduce Frequent Jail Contact

Sarah L. Desmarais, Brandon Morrissey, Lisa Callahan, Samantha A. Zottola, Jen Elder, Kristin Lupfer, Elan C. Hope, & Richard A. Van Dorn

Although most jail admissions represent the only contact a person will have with the criminal legal system, there is a small group of people who experience more frequent jail contact and who represent a disproportionate number of both jail admissions and expenditures.1,2 People with frequent jail contact experience complex, interconnected social, economic, and behavioral health needs that may exacerbate (or be exacerbated by) their frequent jail contact. This group also experiences frequent contact with other services in the community, such as emergency rooms, homeless shelters, and treatment facilities. Strategies to implement services that meet complex needs and address structural barriers are critical to meaningfully and sustainably reduce system involvement among the population of people who experience frequent jail contact.

Effective change for people with frequent jail contact must proceed simultaneously on a systemic, policy level and on the individual services level. The population discussed in this policy brief typically has complicated behavioral and medical health needs, extensive criminal legal encounters, and significant social deficits such as poverty, isolation, and elevated risk of being unhoused. Many of their needs can be addressed with intensive, person-centered treatment in a coordinated continuum of care. The success of community-based solutions is supported by three foundational elements:

  1. A systemwide examination of structural barriers and opportunities,
  2. A focus on policies to effectively implement and support evidence-based interventions, and
  3. A re-envisioning of how the behavioral health and criminal legal systems can coordinate trauma-informed responses for people with frequent jail contact.


1 Elsa Augustine and Evan White, High Utilizers of Multiple Systems in Sonoma County 1-31 (2020), uploads/2020/07/High-Utilizers-of-Multiple-Systems-in-Sonoma-County.pdf.

2 Ross MacDonald, Fatos Kaba, Zachary Rosner, Allison Vise, David Weiss, Mindy Brittner, Molly Skerker, Nathaniel Dickey, and Homer Venters, The Rikers Island Hot Spotters: Defining the Needs of the Most Frequently Incarcerated, 105 American Journal of Public Health 2262–2268 (2015),

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Behavioral Health IMPACT: Addressing Mental Health Disparities in Local Jails

By: Ashley Krider

Jail Populations Mental Health Substance Abuse May 23, 2023

Since 2015, Policy Research, Inc. (PRI) has partnered with MacArthur’s Safety and Justice Challenge (SJC) to reduce the number of individuals involved, or at risk of involvement with, the criminal legal system who have mental illness, substance use, and other complex needs. Studies highlight the importance of concentrating on this population as communities work to tackle the misuse and overuse of jails and create more equitable systems:

As part of the Safety and Justice Challenge, PRI created the IMPACT Network to provide technical assistance to participating communities on issues related to the over-incarceration of individuals with mental illness and substance use disorders. The IMPACT Network communities engage in a peer-to-peer learning model to accelerate best and promising practices in behavioral health reform and jail diversion, with a commitment to pursuing community-driven, race-conscious solutions to reduce harm to populations overrepresented in, or disparately impacted by, the criminal legal system.

The SJC IMPACT Network began in 2021 with a group of 11 jurisdictions.

Over the past two years, these communities have participated in topical technical assistance meetings focused on behavioral health data tracking and evaluation, equity within the intersection of the criminal legal system and behavioral health, developing early diversion strategies, building a robust jail continuum of care, and other critical topics.

The communities participating in the IMPACT Network focus on a variety of strategies to decrease inappropriate incarceration of people with behavioral health needs.

Allegheny County, PA

Allegheny County’s Justice Related Services (JRS) provides assessment, treatment placement, and service coordination to court-involved individuals with mental health or co-occurring diagnoses. They are also focusing on balancing risk and needs during decision making for people with behavioral health needs, developing alternative response to certain 911 calls, and building out a broader continuum of peer supports for court-involved people.

Orange County, CA

In April 2022, the Orange County District Attorney’s Office launched their Focused Intervention Route to Services and Treatment (FIRST Point) pre-filing diversion pilot program. The pilot program connects people who have committed low-level crimes with services to address mental health and substance use issues to ensure a criminal proceeding does not inhibit future work and education opportunities.

San Juan County, NM

San Juan County has worked closely with community stakeholders and cross-agency representatives through their Sequential Intercept Mapping (SIM) process, identifying gaps in services available to individuals with behavioral health needs. As part of their post-SIM work, the county plans to identify a system for data collection that will assist stakeholders in tracking the county needs and build planning capacity toward creation of a mental health drop-in center.

In early 2023, PRI expanded the IMPACT Network by adding six additional communities: Doña Ana County, NM; Solano County, CA; Sarpy County, NE; Douglas County, NE; Issaquah, WA; and Natrona County, WY, for a total of 17 jurisdictions. This new group of counties brings to the IMPACT Network communities from the West and Midwest, including several smaller and more rural jurisdictions.

We are excited to further diversify the IMPACT Network and continue this important work toward the goals of reimagining systems, reducing the footprint of local jails, and increasing equity.

A visual representation of the IMPACT network from the SJC’s 2023 convening.


Building an Effective County Behavioral Health Care Continuum

By: Chelsea Thomson

Interagency Collaboration Mental Health Substance Abuse February 17, 2022

Recognizing that too many people spend too much time in jails across America when their deeper need is for behavioral health treatment, counties are deploying innovative programs to help address this problem. To better support community members living with a behavioral health condition such as mental illness and/or substance use disorders, many counties are developing and implementing integrated behavioral health continuums of care.

Building an effective behavioral health care continuum targets the root causes of behavioral health emergencies by investing in comprehensive and accessible prevention, treatment, and real-time intervention. With almost one in four adults in the United States living with a behavioral health condition, county leaders understand the urgency to find approaches that balance community behavioral health needs and law enforcement response during an emergency.

The continuum of care helps people before, during, and after a behavioral health emergency by prioritizing a public health and person-centered approach. This reduces the overreliance on emergency rooms and the criminal legal system as de facto mental health providers.

The National Association of Counties is exploring the challenges and opportunities related to the behavioral health continuum of care in partnership with the Safety and Justice Challenge (SJC). This year we are producing a series of webinars and reports outlining the important work counties are undertaking in this space.

The first webinar in January focused on helping people before and after an emergency. Representatives from Orange County, NY, Johnson County, IA, and Hennepin County, MN discussed ways to assist people in the community through coordinated and wraparound services that often address social determinants of health. One panelist was Leah Kaiser, Director of Behavioral Health and Justice Strategy in Hennepin County—a community participating in SJC.

“Hennepin County includes Minneapolis. The impact of George Floyd in 2020 dramatically impacted our partnerships with law enforcement, with community providers, and with our communities,” Kaiser said. “We are really starting to reap the rewards that come from breaking down siloes to meet people’s needs.”

Kaiser discussed “intercept zero” of the sequential intercept model (SIM). The SIM details how people with behavioral health conditions come into contact with and move through the criminal legal system. Kaiser showed how practices such as care coordination, peer support and connections, and referrals to social services can help to address the underlying drivers of behavioral health conditions. It means deflecting people away from intercept one – when law enforcement or emergency services providers often respond to residents experiencing a behavioral health emergency.

“In our system redesign we’ve been centered on ‘what has been their experience when residents have a mental health emergency?’” Kaiser said. “Today, residents encounter a person, or multiple people, who do not have the right training and can do very little to help them resolve their crisis. The mismatch between training, response, and need is costly to both residents and the system at large. The result puts people on a path of repeated traumatic exposure, overuse of inappropriate interventions, and poor health outcomes.”

The system redesign in Hennepin County involved people from across the community, Kaiser said.

People facing a behavioral health emergency often have socioeconomic, health, and emotional needs across systems and are best served when those systems work together. That is why a recovery-oriented and cross-systems approach can stabilize a person in distress and equip them with the tools to effectively mitigate a future need before it turns into an emergency.

With differing needs, counties may prioritize pieces of the continuum but can best serve residents by supporting them throughout each step of their behavioral health condition. It is important to support community members during an emergency by providing them with someone to talk with, someone to respond, and somewhere to go—a framework created by SAMHSA—but services before and after are critical too. No one element of the continuum alone will resolve a problem.

The next webinar on February 22 will highlight counties that are using federal American Rescue Plan Act (ARPA) funds to support the behavioral health needs of their residents. Many counties are dedicating federal resources to programs and practices such as stabilization centers or providing mental health services in libraries and recreation centers. Counties are also deploying ARPA funds towards justice and public safety efforts.

As part of the SJC, NACo supports a dozen counties through the County Justice Peer Learning Network. Over the past two years, these counties have developed action plans and implemented practices to reduce the number of individuals living with a behavioral health condition in jails. They are bolstering their behavioral health continuums of care by increasing coordination across agencies and programs (Whatcom County, WA), launching a crisis triage center (Douglas County, KS), deploying a pilot mobile response unit pairing a paramedic and mental health worker (Dane County, WI), and expanding mental health diversion in the court system (Durham County, NC), among other accomplishments.

The future looks rich for a deeper discussion about behavioral health continuums of care. It should involve the right people in getting the right outcomes and keeping people out of jails who would be better served by treatment and support in the community.

Middlesex County, MA

Action Areas Diversion Mental Health

Last Updated

Background & Approach

The Middlesex County Restoration Center Commission was created by the Massachusetts Criminal Justice Reform Act of 2018 with the goal of researching and developing a model for diverting people with behavioral health conditions from arrest or unnecessary emergency department utilization. The Commission found that disproportionate numbers of people with mental health and substance use needs are (1) interacting with police, (2) incarcerated or detained, (3) utilizing emergency departments for behavioral health assessments even when inpatient hospitalization is not the outcome, and (4) “boarding” (waiting more than 72 hours) in emergency departments while awaiting psychiatric inpatient beds.

As a result of these findings, the Commission designed a model for a Restoration Center pilot in Middlesex County. The model seeks to address the identified gaps and needs in Middlesex County, drawing on best practices and evidence-based programming from around the country. A Restoration Center pilot in Middlesex County will seek to provide urgent and crisis care with core components including triage and assessment with medical clearance, crisis stabilization for both mental health and substance use, respite, and aftercare planning including case management and social determinants of health navigation. The Commission and its partner, Commonwealth Medicine, now seek to identify additional sources of funding and procure a vendor to launch a pilot Restoration Center.

Lead Agency

Middlesex Sheriff’s Office and Massachusetts Association for Mental Health

Contact Information

Catia Sharp
Commonwealth Medicine, a division of UMass Chan Medical School


Massachusetts State Senate Office of Senator Cindy Friedman; Massachusetts State General Court Office of State Representative Kenneth Gordon; Massachusetts Association for Behavioral Healthcare; Bedford MA Police Department; MA Office of the Trial Court; the National Alliance for Mental Illness (NAMI) Massachusetts; Massachusetts Executive Office for Health and Human Services; Massachusetts Department of Mental Health; Massachusetts Bureau of Substance Addiction Services

West Texas Centers, TX

Action Areas Diversion Mental Health

Last Updated

Background & Approach

West Texas Centers (WTC) is a community mental health center located in Big Spring, Texas. Since its inception in 1997, WTC has provided mental health services for individuals in 23 counties covering an area of 25,000 square miles.

West Texas Centers is committed to working with local governments to decrease the population of people with mental illness in our jails.

There has been much progress so far in this effort by the implementation of our Mental Health Deputy program and our Community Mental Health Grant: Jail Caseworker program. These two programs are unique in that our mental health staff have partnered up with local Sheriff’s departments and are integrated into each other’s systems. The staff in these programs are able to be the intercepts between Mental Health and Criminal Justice.

However there are still many challenges with not having a place to divert people with mental illness away from the jails.

West Texas Centers recognizes the lack of resources in our rural communities. This challenge has created our drive to work harder with local partners and continue our quarterly Jail Diversion Committees. Our Jail Diversion Committee includes; local Sheriff’s, Jail leadership, Parole/Probation, West Texas Centers mental health and IDD key staff, Hospital representatives, local County Judges, people with lived experience (Peers), State hospital representative and VA representative. Our strategies while working with the IMPACT Network sites are to implement new programs within the intercept model to divert people with mental illness from the jails. By learning from others in the network, we can create something that fits our smaller communities.

Specifically having more specialized court dockets with training for the judges on mental health and SUD issues. West Texas Centers also would like to work with local partners to design and implement a diversion center for law enforcement to utilize when they only have one choice; the jails.

Lead Agency

West Texas Centers

Contact Information

Patricia Watlington


Members of our Jail Diversion committees