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Many in LA jails could be diverted into mental health treatment

January 07, 2020

More than 3,300 people in the mental health population of the Los Angeles County jail are appropriate candidates for diversion into programs where they would receive community-based clinical services rather than incarceration, according to a new RAND Corporation study.

Based on a variety of clinical and legal factors, researchers estimated that about 61% of the individuals in the jail mental health population were appropriate candidates for diversion, 7% were potentially appropriate for diversion and 32% were not appropriate for diversion.

The study, which was based on a review of the jail population as of June 2019, has findings that are similar to preliminary estimates compiled earlier by L.A. County officials.

"Knowing how many people are appropriate for diversion is a first step toward understanding the types of programs, staff and funding that would be needed to treat those individuals in the community," said Stephanie Brooks Holliday, the study's lead author and a behavioral scientist at RAND, a nonprofit research organization.

The largest mental health facilities in the U.S. are now county jails, with an estimated 15% of men and 31% of women who are incarcerated in jails nationally having a serious and persistent mental disorder.

In Los Angeles County, 30% of the people incarcerated in the county jail on any given day during 2018 were in mental health housing units and/or prescribed psychotropic medications (5,111 of 17,024 individuals in the average daily inmate population).

The Office of Diversion and Reentry was created by the county in 2015 to develop alternative approaches to dealing with mental health challenges in the criminal justice system. While L.A. County officials have been pursuing alternatives for individuals with serious mental illness who are incarcerated, there is more demand for the existing services than there is capacity.

RAND was asked by L.A. County to estimate the size of the current population of individuals incarcerated in county jails who likely would be legally suitable and clinically eligible for community-based treatment programs. The study was not limited by the availability of existing services, and considered who could be diverted assuming no limits on the types of programs or number of treatment slots available.

RAND researchers developed a set of legal and clinical criteria that reflect the general factors that the Office of Diversion and Reentry currently uses to determine whether an individual may be put forward to the courts as a candidate for diversion.

The principles were applied to a sample of 500 people who are representative of the L.A. County jail mental health population. Researchers found that about 59% of men and 74% of women were determined to be appropriate candidates for diversion. Men make up 85% of the Los Angeles County jail mental health population.

"Diversion is stopping the cycle between jail and homelessness," said county Supervisor Mark Ridley-Thomas. "Just in the last three years, the Office of Diversion and Reentry has safely diverted over 4,400 people from the county jails to more appropriate settings where they can get treatment, instead of the costly alternative of serving additional time in jail and being released with no supports, too often ending up homeless. This is smart policy making. RAND's research underscores the need to double down on diversion to reach all those who could benefit."

In addition to increasing diversion programs, RAND researchers suggest that L.A. County improve its ability to collect information about individuals released into community-based programs, the ways different courts handle such cases and the outcomes of people placed into diversion programs.

The county also could look for ways to improve its early diversion efforts, which may be able to help people before they enter the county's criminal justice system. For example, some jurisdictions intervene at the point of arrest in an effort to decrease the criminalization of persons with mental illness.

"But even with increases in diversion, there will continue to be a large number of individuals with mental health needs who remain in the jails," Holliday said. "It is important that there are services in place to care for people who are incarcerated and provide continuing services once they are released back into the community."

The report, "Estimating the Size of the Divertible Jail Mental Health Population in Los Angeles County," is available at http://www.rand.org. Other authors of the study are Nicholas M. Pace, Neil Gowensmith, Ira Packer, Daniel Murrie, Alicia Virani, Bing Han and Sarah B. Hunter.
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The RAND Social and Economic Well-Being division seeks to actively improve the health, and social and economic well-being of populations and communities throughout the world.

RAND Corporation

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