Toward successful postbooking diversion: What are the next steps?

Objective: The authors reviewed studies of U.S. postbooking jail diversion programs for adults with serious mental illness. Questions regarding clients who are most appropriate for diversion, types of existing programs, progress in substantiating beneficial outcomes, and factors that might predict successful diversion are addressed. Methods: PsycINFO and MEDLINE databases were searched for articles published between 1999 and 2008; the following keywords were used: jail diversion, mental health diversion, serious mental illness, and criminal justice. Results: Although accumulated data do not give a complete picture, clients served by postbooking diversion programs are diverse in demographic and clinical characteristics and criminal history; their needs, which are great, are driven by this diversity. Programs use several approaches, including assertive community treatment, intensive case management, intensive psychiatric probation and parole, mental health courts, and residential support. Much of the outcome evidence is at the client level, such as a reduction in criminal justice contacts and, over the longer term, in hospitalizations. At the system level, effects such as greater use of mental health services and changes in the distribution of use have been documented, although research on cost-effectiveness is needed. Data on outcomes at the community and the broader societal levels are scarce or non-existent. Definitive evidence is lacking on factors predicting successful diversion; however, mandated treatment may increase the likelihood of program completion. Conclusions: Many strategies have been developed for diverting clients with serious mental illness from the justice system, but more research is needed, especially on how to enhance positive outcomes of diversion programs.