Counties could save money and keep more people out of jail by improving access to community-based mental health and substance use disorder services, according to a study led by a Michigan State University College of Human Medicine professor.
The study published by Psychiatric Services, a journal of the American Psychiatric Association, identified 59 recommended mental health practices, but found that United States counties, on average, offered only a few of them.
“The importance of this study is that most counties offer only a tiny fraction of the community services that are necessary to keep people out of jail,” said the study’s lead author, Jennifer Johnson, C.S. Mott Endowed Professor of Public Health at MSU. “We’re hoping that by publishing this article, county administrators will look at the list of services that they don’t yet offer and try to make them happen.”
The researchers, including Maji Hailemariam, a College of Human Medicine assistant professor, reviewed earlier studies to identify the 59 effective practices and then surveyed 950 U.S. counties to ask which of those services were available to people interacting with police, 911, courts, jails, probation or parole.
Most counties offered very few of the recommended mental health and substance use disorder services. For example, only 29.2% of the counties offered permanent supportive housing for individuals with mental health conditions and only 27.2% offered assertive community treatment. Both services are helpful for keeping individuals with serious mental illness stable in the community and out of jail.
The lack of adequate treatment programs was particularly acute in rural counties, the study found.
Because Medicaid is suspended for those who are incarcerated, even for a day, the authors recommended that counties help reinstate that coverage when a person is released.
“We’ve had people who have been standing in line at the pharmacy to get their medications,” Johnson said, “and they’re told, ‘Your Medicaid is suspended because you’re in jail,’ and yet the person is standing right there.”
While some of the evidence-based services can be offered by county jails, most can be provided through community mental health and other community-based programs, Johnson said.
Offering treatment for physical pain to prevent addiction to opioids can alleviate the burden on county jails, she said, as can providing supported employment or walk-in crisis centers.
Permanent housing and employment combined with professional and/or peer support “are better than keeping people in jail,” Johnson said, “and they’re 100% cheaper. Our goal is to keep people treated and stable in the community and not cycling through local jails.”
