The United States needs to do a better job at reducing the incarceration of individuals with mental health and substance use disorders, according to a new Human Rights Watch report* released May 12, 2015.

“U.S. prisons and jails have taken on the role of mental health facilities,” the report states, citing one estimate that at least 360,000 men and women with serious conditions such as schizophrenia, bipolar disorder and major depression are confined. 

“This new role reflects, to a great extent, 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 offenses.”

Increased collaboration among the criminal justice and behavioral health care systems is necessary, the report asserts, to ensure appropriate interventions for people with mental health and substance use problems at every stage of the criminal justice system.

Human Rights Watch calls for reducing the number of people confined in prisons and jails who have mental disabilities and substance use issues, and increasing the availability of community mental health resources and access to criminal justice diversion programs.

With that in mind, Optum® asked Tim Whalen, director of Salt Lake County Behavioral Health, to explain the benefits of jail diversion programs and alternatives to incarceration and describe his experience working with Optum to implement such programs in Utah.

Some say that the number of people incarcerated today who have mental health or substance use disorders is at crisis level. Do you agree?

Absolutely. Over 50 percent of inmates currently in federal prison are there for a drug offense. A large portion of that group will present with both substance use and co-occurring mental health issues. 

Many are in jail just for exhibiting the symptoms of their illness — being combative, argumentative or agitated because they’re confused or haven’t taken their medication. Jail is the last place you want these individuals in terms of outcomes.

And from a cost perspective, it’s estimated that incarcerating individuals with psychiatric disorders costs twice as much as an assertive community treatment approach.

What types of behaviors would qualify someone for a jail diversion program rather than incarceration?

It could be a public nuisance or public urination charge, or they’ve been asked to leave a setting or a store and they get combative or argumentative because they’re confused. They could be agitated because they haven’t been in compliance with their medication. 

Some people call the police because they feel threatened, even though the person wasn’t intending to harm them. Being under the influence of drugs or alcohol may exacerbate this behavior, and they become even more of a nuisance and unmanageable.

How do jail diversion programs help individuals with mental illness or substance use disorder?

Salt Lake County has always prioritized having quality mental health services and addiction treatment services in our jail. Not all jails do. I wouldn’t want to qualitatively say they’re no good. The mental health professionals in the jails are doing the best they can.

However, the literature shows that placing these individuals in treatment programs within their community, where they have the support of family and friends, offers a lower rate of recidivism than does incarceration. 

If we divert them into good health care, whether it’s substance use disorder treatment or mental health care, and we address other deficits, like housing and employment skills, many of them will become great law-abiding, tax-paying citizens.

I also believe that from a humanitarian perspective, treating a health issue in the community is much more responsible than incarceration. Locking someone up based on the symptoms of an illness produces horrible outcomes.

Please expand on how jail diversion programs help save taxpayer money.

By law, you can’t use Medicaid dollars to treat the mentally ill inside a jail. You have to use local tax dollars. That becomes costly. Programs on the outside, however, qualify for Medicaid and the federal match.

Incarceration is expensive; the costs are even higher when you have inmates with substance use or mental illness. If even half of the law enforcement referrals to our two crisis centers in Salt Lake County prevent booking and jailing, we can save over $650,000 in one year.

It must be expensive to develop jail diversion programs. Is it worth it?

Definitely — not only from return on investment, but especially if many of your residents are Medicaid eligible. 

By diverting individuals to community resources rather than treatment within a correctional facility, you can leverage the federal dollar and provide more services to more individuals — including the behavioral health services that keep people out of jail.

What do these types of services mean to people in crisis?

I think it means everything to them and their families. It’s traumatizing to be taken to a psych hospital, to be admitted and then to stay there for a period of time.

Any time you can keep them close to their family or in the community, with the support of peer specialists, it produces better outcomes.

How has Optum brought value to the Salt Lake County, Utah, Medicaid crisis services? Is there anything in particular you’d like to point out?

I think the crisis services Optum developed are amazing. I am particularly pleased with the peer specialists. Optum brought in the idea of using peer specialists very early in the game. 

A peer specialist is someone who’s in recovery. They’ve had some of the same experiences of being in crisis and interfacing with law enforcement. 

They’ve experienced what it’s like to be transported to a psychiatric facility and are extremely valuable in calming someone and providing perspective. 

Most of the time, after talking with a peer specialist, the person can return to the community without hospitalization.

I would also like to point out the ACT — assertive community treatment — teams that Optum put in place. 

These are our “hospitals without walls.” They go into the community as case managers, providing needed services, so people with mental health issues can stay at home rather than be hospitalized.

Have the crisis services Optum implemented lowered health care costs?

Our inpatient reports show that, since Optum came in, we’ve decreased our psychiatric inpatient spend, and from what we’ve seen, the folks who enter the wellness recovery center — who would’ve historically been hospitalized — are not being hospitalized. 

A large portion of the individuals who receive our crisis services are being diverted from inpatient care.

Have these services worked, in terms of jail diversion?

From July 1, 2015, to June 30, 2016, law enforcement referred 1,555 individuals in a behavioral health crisis to our mobile crisis teams or the receiving center. If even half of the referrals prevented booking and jailing, the county would have saved over $1.5 million.

What do you think Optum brought to the table that others may not have?

Optum was willing to work with Salt Lake County and our local stakeholders to customize their ideas to meet community needs. Optum was a great partner, adapting services to how we needed them. 

They even took us to Pierce County, Washington, and showed us the crisis service lines they implemented there.

What is it about our partnership that makes you glad you chose Optum?

Optum has brought a strong commitment and compassion to the job. They really do care about the clients and the services. And they take a lot of pride in meeting the needs of those clients. They absolutely met all of our expectations.

It’s been a great success. Even the state looks to what we’re doing with peer specialists and our other initiatives. I think we’re setting the standard here.