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Aug 2, 2010

A Mercer County, New Jersey program proves the wisdom of providing subsistence assistance to former inmates who are mentally ill.  Members of Assistance to the Incarcerated Mentally Ill (AIMI) advocate for two methods to decriminalize mental illness in America:  1) Pass federal bill H.R.619 to resume Medicaid for inpatient psychiatric treatment for middle class and indigent mentally ill Americans. Medicaid for inpatient psychiatric care was eliminated in the 1970's and led to today's crisis:  1.25 million of the nation's mental patients are prisoners, mostly due to avoidable crimes committed by people who were not being treated for their mental illness; and 2) Use assisted outpatient treatment (AOT) programs for chronic mental patients exiting jails and hospitals.  AOT programs that combine mandated psychiatric treatment with subsistence assistance reduced homelessness, arrests, hospitalizations, and incarceration among program participants in New York by around 85% as compared to their experiences three years before joining the program.  New Jersey's program of monitoring and supporting mental patients after prison release further prove that it is humane and financially prudent to give mentally ill ex-prisoners the support they need to live wholesome lives and avoid recidivism.  See an exciting article about the Mercer County program below.

New Services for Released Prisoners With Mental Illness in Mercer County, N.J. -

(June 28, 2010) -- In 2005, Greater Trenton Behavioral HealthCare launched an initiative to assist released prisoners in Mercer County, N.J., who suffered from mental illness and substance abuse problems. The project was funded under New Jersey Health Initiatives (NJHI), a national program of the Robert Wood Johnson Foundation (RWJF).

The agency partnered with a range of organizations representing government, health care providers, the mentally ill and ex-offenders to:

  • Implement a model for prisoner discharge planning and services geared to the needs of those with serious mental illness or substance abuse problems.
  • Gather data useful in reevaluating statewide public policy for serving former prisoners with serious mental illness or substance abuse problems, including:
    • The risk of hospitalization or re-incarceration
    • The level of services needed
    • Follow-through and adherence to treatments

A project advisory committee, made up of staff and representatives of the partnering organizations, provided guidance and coordination. For a list of the project's partnering organizations, see Appendix 1.

Key Results

Greater Trenton Behavioral HealthCare reported the following results to RWJF in 2008:

  • From July 2005 to June 2008, Greater Trenton Behavioral HealthCare received grant support under NJHI to provide re-entry assistance to 176 people—45 from state prisons and 131 from the county jail. These clients received assessment, discharge planning, case management, service coordination and needed follow-up services for 12 months or more. Services included:
    • Assistance in obtaining public benefits (120 clients, or 68 percent of those served)
    • Providing medication (88 clients, or 50 percent of those served)
    • Linking clients to treatment (79 clients, or 45 percent of those served)
    • Securing housing (111 clients, or 63 percent of those served)
  • Re-incarceration rates during the project were substantially lower than the national average:
    • Of those released from state prisons, 20 percent (9 of 45) were re-incarcerated. The national average for state prisons is 81 percent.
    • Of those released from the jail, 30 percent (39 of 131) were re-incarcerated. The national average for local jails is 79 percent.
  • The project fostered a broad-based systems change in the handling of released prisoners, including:
    • Providing re-entry services to state prisoners with mental illness
    • Improving access to financial assistance for re-entering prisoners
    • Improving the quality of treatment through staff training
    • Better service coordination among courts, corrections and health agencies


For project findings comparing those released from state prison to those released from jail, see Appendix 2.

Lessons Learned


  1. When working with the prison and county jail systems, do not rely on predicted release dates. Staff planned to work with clients for three months prior to discharge, but this was not possible since—especially for jail clients—discharge dates were often unpredictable with clients tending to be released earlier than anticipated. (Project Director)
  2. Several factors predict positive outcomes for clients remaining in the community, including:
    • The client is linked to treatment and receives medication.
    • The client has permanent housing.
    • The client's case manager completes an intervention within one week of release. (Project Director)
  3. Many former prisoners with mental health or substance abuse problems need longer support than the nine to 12 months of follow-up originally envisioned in the project because of the severity of challenges this population faces. (Project Director)



RWJF provided a $300,000 grant to Greater Trenton C.M.H.C., Inc. (the incorporation name for Greater Trenton Behavioral HealthCare) for this project from July 2005 to June 2008. Mercer County, N.J., and the New Jersey Division of Mental Health Services also provided funding.


Mercer County and the New Jersey Division of Mental Health Services continued to fund the project after RWJF support ended. The state agency also has contracted with Greater Trenton Behavioral HealthCare to expand the effort by intervening when a person with mental illness first comes in contact with the justice system. The goal is to provide treatment in lieu of incarceration.

With a grant from RWJF (ID# 063162), Greater Trenton Behavioral HealthCare offered free technical assistance in 2009 to organizations helping former prisoners with mental illness. This included a conference on November 13, 2008, in Monroe Township, N.J. Some 154 individuals representing corrections, mental health, governmental and other organizations attended.

Mary Neal
Assistance to the Incarcerated Mentally Ill


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Posted: Aug 2, 2010 12:15pm
Mar 7, 2010

Dog Justice


From the website, Wrongful Death of Larry Neal

A young mother became alarmed in her local grocery store when she realized that her active three-year-old son was no longer trotting along behind her as she shopped. She and the store personnel hurriedly searched up and down the aisles looking for him and calling his name. They found the little tot sitting on the floor near the checkout on aisle 7, surrounded by colorful candy wrappers. He had opened dozens of different candies and sampled each one! His mouth and chin were covered with chocolate, and melted candy was smeared across his shirt and on the floor around him.

In a similar incident, my brother, Larry, walked into a supermarket one summer day, taking the opportunity to enjoy the air conditioning, for it was oppressively hot outside. As he walked down the fresh food aisle, his eyes fell on the rows of plump, sweet grapes. He stopped at that display, and with no effort to conceal his actions, Larry began to eat the grapes. They were cool and good, and he laughed aloud, delighted at how pleasant they tasted. Larry was interrupted in his consumption by an angry clerk who was yelling and pointing at him, directing the store guard to restrain that thief while the police were called. In fact, Larry was no more a thief than the three-year-old, because neither of them was acting out of malice, and in both scenarios an essential element of crime was missing: intent. Indeed, neither the three-year-old boy nor my mentally ill brother, in his diminished capacity, was capable of planning and executing a real crime.

The child rebelled when his mother lifted him away from the sweet feast. The youngster began to cry loudly and struggle against his mother to get back to “his” candy. But the boy’s mother was bigger and stronger than he was, and she effortlessly carried him away from the scene of his “crime.” Contrarily, no one in Larry’s family was big or strong enough to extricate him from the many situations his mental illness caused as he wandered at will the streets of Memphis. Indeed, Larry’s family was not allowed to either restrict his movements or enforce psychiatric treatment and drugs to help him. After all, mentally unstable people like Larry have their rights!

There are those organizations that denounce enforced hospitalization and treatment of the mentally ill, calling such intervention a violation of civil rights. The sincere efforts of such organizations may benefit those mentally ill persons who manage to stay clear of our nation’s jails; however, for thousands of others like Larry, it is just as unreasonable to expect them to run their own lives without psychiatric drugs and restraint as it would have been for the young mother to allow her little boy to finish the candy at his leisure and then find his own way home. Let those organizations fight not only for the rights of the moderately mentally ill, but let them also fight for inpatient care for mentally ill men and women who are today serving time for committing crimes they cannot even understand as well as for scores of mentally ill persons who are homeless, living under wretched conditions and deprived of treatment that might restore them to wholesome lives. (Visit the website for more information on Larry - how he lived, how he died.)  ____________________

Please join the 230 members at Assistance to the Incarcerated Mentally ill and the 230,000 members of NAMI in supporting H.R. 619 to resume Medicaid funding for inpatient psychiatric care.  That will help people in crisis to have short-term hospitalization to stabilize them, and it would provide long-term care for patients whose conditions require containment and constant monitoring.  Long-term hospitalization is requried for violent patients as well as harmless people like Larry who cannot function at an acceptable level because of acute mental illness.

I know criminalizing mental illness cannot last much longer.  America has too many decent people in decision-making capacities.  All voters are in decision-making capacities, so that means YOU.  Please contact your representatives today and ask where they stand on H.R.619 to fund inpatient care for psychiatric patients, and tell them where you stand.  I hope you and your representatives will stand with NAMI and AIMI members as we seek to give ASSISTANCE TO THE INCARCERATED MENTALLY ILL.


Mary Neal

Assistance to the Incarcerated Mentally Ill

Jul 26, 2009
Americans with Disabilities

Position Statement 52: In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System

Statement of Policy

Mental Health America (MHA) supports maximum diversion from the criminal justice system for all persons accused of crimes for whom voluntary mental health or substance use treatment is a reasonable alternative to confinement or other criminal sanctions.  MHA urges the utilization of diversion programs at the earliest possible phase of the criminal process, preferably before booking or arraignment.  Conversely, MHA supports minimizing the use or threat of use of criminal sanctions to compel mental health treatment.  These principles apply with equal force to adults and juveniles.

MHA supports the long-term goal of integrating persons living with mental and substance use conditions into a culturally competent community-based mental health care system focused on consumer empowerment and quality of life, and aimed at their recovery.  Over the past two decades, jail diversion programs have emerged as a viable and humane alternative to the criminalization and inappropriate criminal detention of individuals with mental and substance use conditions. Diversion programs have been heralded for their potential benefits to the diverted persons, the criminal justice system and the community.

Another critical issue for individuals with a mental or substance use condition is that of coercion.  With a deeper understanding of the role of recovery in the successful treatment of mental health or substance use problems, MHA is wary of the expanded use of the criminal justice system, with its increased focus on persons with mental illness, as a substitute for voluntary community-based treatment that mental health advocates have consistently sought.  The sense of dependency and helplessness that comes from linking treatment to incarceration is at the core of the need for effective diversion.  

MHA encourages local and state affiliates, consumers, stakeholders, and other advocates to support the development of diversion strategies that promote police officer training, community engagement, and early intervention in an effort to keep persons with mental and substance use conditions out of the criminal justice system. 


An estimated 11.4 million people are admitted to local jails every year in the United States.  On any given day, about 2 million people can be found incarcerated in U.S. prisons or jails.   According to the President’s New Freedom Commission on Mental Health’s Interim Report, approximately 5-7 percent of adults have a “serious mental illness.” The Federal Regulations define “serious mental illness” to mean any diagnosable mental disorder that affects work, home, or other areas of social functioning.  The Bureau of Justice Statistics reported that since midyear 2005 more than half of all prison and jail inmates had a mental health problem.  Fifty-six percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem.  Mental health problems were defined by two measures and must have occurred in the 12 months prior to the interview.  One measure was a recent history of mental illness, by clinical diagnosis or treatment by a mental health professional.  The other, symptoms of a mental health problem based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, DSM-IV).  People with mental health and substance use conditions are repeatedly arrested for petty offenses. 

The Surgeon General’s report entitled Mental Health: Cultural, Race, and Ethnicity showed that disparities existed in mental health systems for persons of diverse populations and that mental and substance use conditions exacted a greater toll on their overall health.   National indicators show that persons of color are disproportionately represented in both adult and juvenile justice systems.  Studies also show that while there are few, if any, differences in the nature and scope of crimes committed by persons of color in comparison to their white counterparts, their rates of arrest, prosecution, and incarceration, as well as the length of sentences, are substantially higher.

Fewer than 5 percent of jails polled nationwide in 1992 had procedures to divert inmates with mental health conditions from the criminal justice system into the mental health treatment system. Since then, the establishment of jail diversion programs has become more commonplace.   There have been 294 jail diversion programs in operation since 2003, 17 of which were funded by SAMSHA’s Center for Mental Health Services.

Another form of diversion has also arisen by way of Mental Health Courts. In 2000, The Mental Health Courts Program was created by "America's Law Enforcement and Mental Health Project" (Public Law 106-515).  In 2003, the Bureau of Justice Assistance funded 23 of these courts which helped to relieve over-burdened criminal courts that ordinarily handled all cases relating to mental health. Participants in a study focusing on mental health courts reported improved quality of life and demonstrated greater gains in developing independent living skills and reduced drug problems and new criminal activity. Today, more than 150 of these courts exist, and more are being planned.

The extraordinary human and financial costs to the criminal justice system argue strongly that effective diversion may produce better results at a lower cost.  Community-based programs for people with mental illness and substance use conditions would help to provide not only appropriate treatment for them, but would decrease duration or even prevent incarceration altogether.  Four SAMHSA-sponsored jail diversion programs have recently released data showing the most well-controlled cost-effectiveness results to date. Costs were defined as those from all court appearances, public defenders’ and prosecutors’ offices, the police, and incarceration days.

Mental health problems among the population of persons in the nation’s jails and prisons are serious and growing.  In New York State, a five-year study of persons in the mental health and correctional systems established that men who were involved with the public mental health system were four times as likely to be jailed as men in the general population.   Another published report on a New York City jail found that the average length of stay for a mentally ill inmate was 215 days, as opposed to 42 days for all other inmates. The Los Angeles County Jail, Cook County Jail in Chicago and New York City’s Riker’s Island “each hold more people with mental illness on any given day than any hospital in the United States.”    The Los Angeles County Jail has for a number of years been declared to be the largest mental health facility in the country. In an era of deinstitutionalization, jails and prisons have become de facto mental health treatment facilities.

People with mental and substance use conditions in jails and prisons have complex and challenging needs. Almost 75 percent have co-occurring mental health and substance use disorders. Homelessness is widespread in the mental health community as well.  Inmates with mental health conditions are twice as likely to have experienced homelessness in the year prior to arrest compared to inmates not diagnosed with mental illness.   Half of the inmates with mental health conditions in prison were incarcerated for committing nonviolentcrimes.   Many have been incarcerated for minor offenses such as trespassing, disorderly conduct and other symptoms of untreated mental illness. 

Call to Action

The increasing involvement of persons with mental health and substance use conditions in the criminal justice system has enormous fiscal, public safety, health and human costs.  Diverting individuals with mental  and substance use conditions away from jails and prisons and toward more appropriate and culturally competent community-based mental health care has emerged as an important component of national, state and local strategies to provide effective mental health care; to enhance public safety by making jail and prison space available for violent offenders; to provide judges and prosecutors with alternatives to incarceration; to provide specialty training to law enforcement and probation personnel to deal effectively with mental health and substance use issues; and to reduce the social cost of providing inappropriate mental health services or no services at all.  The success of diversion programs in communities across the country is generating genuine excitement and hope that real progress can be made in meeting the challenge of criminalization and reducing the toll it exacts on these individuals, their families, service agencies and the criminal justice system.

Mental Health America recognizes that the development of diversion programs involves negotiation between the mental health system, law enforcement officers, public defenders, prosecutors, court personnel and others in the criminal justice system.  Each community must reach consensus on the type of diversion program appropriate for that community and the severity of offenses that may disqualify offenders from participation in the program. However, the principal consideration should be assuring that careful consideration is given to diversion of persons with serious mental and substance use conditions despite their charges, which may be more reflective of stigma than the real severity of the offence.

There are two major kinds of jail diversion programs: pre-arrest and post-arrest.

Pre-Arrest ( Pre-Booking ) Diversion Strategies

Pre-arrest strategies typically focus on the law enforcement officers that are often the first point of contact with persons with mental or substance use conditions in crisis.   Since their initial interactions with persons with mental or substance use conditions are so critical to determining the situation’s outcome (i.e., whether or not an individual is to be jailed), pre-arrest jail diversion strategies rely heavily on helping police become knowledgeable regarding the nature of mental and substance use conditions, provide tools to de-escalate crisis situations and provide options for treatment alternatives to incarceration that are available in the community.  

Examples of pre-arrest strategies include: police training to recognize the signs of mental illness and substance use; deployment of a mobile crisis response team that provide assistance and support to police and the individual; and transportation to treatment rather than jail.  Culturally competency is a critical component of such training, to avoid the unequal treatment that comes from stereotyping racial and cultural groups. 

Post-Arrest ( Post-Booking ) Diversion Strategies

Post-booking diversion programs are the more common type of jail diversion program in the United States.  After formal charges have been filed, post-booking programs screen individuals to determine the presence of mental or substance use conditions; negotiate with prosecutors, attorneys, courts and mental health providers to dispose of the case without additional jail time; and link the individual with mental health treatment as a condition of a reduction in charges, deferred prosecution or dismissal. 

Mental health courts are an example of a post-booking jail diversion program.  Mental health courts hear cases involving persons with mental health conditions who have been charged with non-violent crimes.  They divert these individuals away from jail or prison by negotiating a treatment program that might include group or day services, psychotropic medication, case management or inpatient hospitalization in order to restore defendants to stable functioning in their communities. 

Diversion Works

Studies show that diversion of persons with mental and substance use conditions accused of misdemeanor crimes into appropriate, community-based mental health treatment programs allows for better long-term results for offenders. A collaborative program between the U.S. federal prison system and community healthcare providers in Baltimore was studied for recidivism among released inmates.   This is one of the few studies that looked at both pre- and post-booking recidivism.  The rate of violation of probation, parole, or supervision was 19% after participation in a diversion program while this same group of offenders had a violation rate of 56% before their current release. Researchers believe this result is attributed in part to the close working relationship between the clinical team and the probation officer as well as clinicians being able to gain a better understanding of the community supervision system. This new cooperation between the contracting agencies would allow all treatment options to be exhausted before sanctions are deemed necessary.  A more recent study has reiterated this finding and shown that program participants incurred less jail days, hospital days, and number of arrests post-program participation compared to one year prior to arrest.

Dismissal of Charges

Mental Health America believes that successfully completed pre-booking and/or post-booking diversion programs should provide for dismissal of criminal charges.  In the case of post-booking diversion, jeopardy of re-involvement in the criminal justice system should be limited in accordance with the criminal justice standards in that jurisdiction.  As a guideline, conditions of deferred prosecution, deferred sentence or probation ordinarily should not exceed one year.

Implementing Effective Diversion Strategies Resources

Timely and accurate mental health screening and evaluation is the single most critical element in a successful diversion program.  More treatment resources are desperately needed.  Communities must develop services that meet the needs of mental health and substance use consumers.  In addition to significant increases in public investment, services must be integrated across public and private agencies.  Individual treatment plans should be focused on consumer recovery and choice and should include: mental and physical healthcare, case management, appropriate housing, supportive education, integrated substance abuse treatment, and psychosocial services, in the least restrictive environment possible.


Diversion programs also require the development of community coalitions, including but not limited to partnerships between criminal justice, mental health and substance abuse treatment agencies.  Criminal justice and corrections agencies should be encouraged to develop new sources of funding to expand diversion programs. Coalitions should also be reflective of the diverse make-up of the community.  Joint mobile outreach services such as crisis intervention teams are a key element in successful partnering between mental health, substance abuse treatment and law enforcement agencies, with effective diversion to an appropriate treatment plan the critical measure of success.  Consumers of mental health and substance abuse services and family members affected by mental illness or substance use need to be included in such coalitions to assure that the real barriers to effective mental health and substance abuse treatment in that community are addressed. 

These community coalitions need to reach out to all criminal justice system personnel to ensure that comprehensive culturally competent training is provided at all levels to deal with issues of mental illness and substance use, wherever and whenever they occur.  Mental health associations should reach out to or create such coalitions whenever possible.  Effective diversion from the earliest point of contact with the criminal justice system of a person with a serious mental illness or serious emotional disorder should be a centerpiece of all mental health planning, with the aim of promoting recovery from mental illness and as an end to all unnecessary use of criminal sanctions.

Effective Period The Mental Health America (MHA) Board of Directors approved this policy on June 8, 2008.  It will remain in effect for five (5) years and is reviewed as required by the Mental Health America (MHA) Prevention and Adults Mental Health Services Committee.       Expiration:  June 2013


Content and comments expressed here are the opinions of Care2 users and not necessarily that of or its affiliates.


Mary Neal
, 5, 2 children
Atlanta, GA, USA
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