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Out of jail and into treatment

August 1, 2006
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Stakeholders in a Texas county work to improve the lives of offenders with serious mental illness

Paul Eisenhauer trains police officers on how to handle offenders with schizophrenia. Once, an officer came up to him and said, “A lot of people are scared of schizophrenics.” Eisenhauer responded, “A lot of people are scared of cops.”

Eisenhauer certainly knows how people with schizophrenia react in encounters with the justice system, for he suffers from the disorder himself. Years ago, Eisenhauer frequently was arrested and jailed, often for minor offenses such as trespassing. Some arrests happened during psychotic episodes. One time an officer who knew about mental illnesses arrested Eisenhauer and took him to the Bexar (pronounced “bear”) County (Texas) Jail Diversion Program's Crisis Care Unit. That day the road to recovery opened. Eisenhauer got into a treatment and support program that helped him reintegrate into the community. Today he is helping the community understand offenders with mental illnesses.

A Nationwide Need

According to the Bureau of Justice Statistics, every year nearly 200,000 individuals with mental illnesses—about 16% of the jail population—languish in our country's jails instead of being connected to proper treatment and supports. Nearly half of these individuals were incarcerated for nonviolent and victimless offenses such as public drunkenness, vagrancy, trespassing, or even attempting suicide. An arrest episode costs taxpayers up to $2,295, and serving an inmate for a day in jail costs up to $300. Once incarcerated, individuals with mental illnesses generally do not have access to adequate treatment, and they often serve up to four times longer than the general prison population for the same offenses.

Making an Impact in Bexar County

Four years ago, Bexar County became an exception to this national trend when the Center for Health Care Services (CHCS), the county mental health authority, started the Bexar County Jail Diversion Program.

“We want to ensure that all those in our community with mental illness and addiction disorders have access to quality care. This means we can’t ignore those in our county's jails. They don’t need to be there simply because there is nowhere else for them to go,” says Leon Evans, executive director of CHCS.

Since 2002, the program has diverted more than 4,000 individuals with mental illnesses from incarceration to treatment and has saved the county an estimated $5 million annually.

The Bexar County Jail Diversion Program is a comprehensive, coordinated service delivery system that focuses on diversion from jail and access to care for individuals with mental illnesses that are about to be or have been incarcerated. The program provides comprehensive screening, increased access to treatment, continuity of care, and support for community reintegration—all within the least restrictive and most clinically appropriate setting.

“We don’t want to send people to jail if they are not a threat to society, and thanks to the county's Jail Diversion Program, we now have many other options,” says Bexar County Judge Polly Jackson Spencer.

Points of Diversion

The Bexar County program comprises three major points of diversion: before, during, and after incarceration.

Diversion point one

First, the program seeks to divert offenders with mental illnesses before they are arrested or booked in the county jail. Deputy Mobile Outreach Teams, in which deputies partner with mental health clinicians, screen offenders for mental illnesses and refer them to the 24/7 Crisis Care Center. CHCS was instrumental in starting this center, which has ten 23-hour holding beds and offers joint medical and psychiatric screening. The center has reduced wait times for screening from 14 hours to 1 hour.

Crisis Intervention Teams, staffed by specially trained police officers, help to resolve conflicts during encounters with individuals with mental illness. Officers on these teams receive training (provided by CHCS in partnership with the San Antonio Police and Sheriff's Office) on how to handle offenders with mental illnesses.

Diversion point two

The Bexar County Jail Diversion Program identifies persons with mental illness already in jails and tries to have them released to treatment through mental health bonds (judicial orders predicated on the persons’ compliance with treatment).

In accordance with a Texas State mandate, CHCS runs public data on individuals arrested against its own database of consumers with mental illnesses and alerts the state if offenders have prior mental health indicators that warrant special handling, screening, and intervention.

A pretrial services component helps to identify individuals in jail who are nonviolent and have no history of major crimes but suffer from severe mental illnesses and co-occurring mental health and addiction disorders. The program provides for such individuals to be diverted from jails and linked to available mental health treatment and support services. Charges are usually dropped, but this is subject to judicial discretion.

Diversion point three

The final point of intervention focuses on providing appropriate mental health services to individuals upon their release from jail.

CHCS established a 60-bed residential “step down” program and a 100-bed drug abuse treatment facility, resulting in a jail-to-treatment option for local judges. “We pave the way for people in jail to get into active treatment upon their release, and we help them find jobs and housing. Our goal is to help them reintegrate into the community,” says Evans.