Identifying Practices for Reducing Incarceration of Those with Mental Illnesses—A Study of “Stepping Up”

February 25, 2020 • Research Highlight

According to a 2017 report by the Bureau of Justice Statistics , approximately two-thirds of female inmates in prisons and jails and around a third of men in prisons and jails report having been diagnosed as having mental health disorder by a mental health professional. Of those who enter jail each year with a serious mental illness, an estimated three quarters have a co-occurring substance use problem.

Addressing mental health and substance use concerns in an incarceration setting can be costly, time-consuming, and often challenging. Additionally, release from incarceration is a high-risk time when the connection to community-based treatment and services may not occur, contributing to poor long-term outcomes for individuals involved with the criminal justice system.

The National Institute of Mental Health (NIMH) awarded more than 3.5 million dollars in research funding over the course of five years to examine the Stepping Up Initiative , a national effort to reduce the number of people with mental illnesses in jails. The NIMH-supported research will help determine the efficacy of this initiative and how it works — findings that may inform future policy changes related to this multi-need population.

Stepping Up  is led by the Council of State Governments, the National Association of Counties, and the American Psychiatric Foundation, and currently involves 500 U.S. counties — making it the largest-ever effort to set up systems to redirect justice-involved people into needed treatment and services. The initiative seeks to foster improved communication and shared goals between providers and administrators in the behavioral health and criminal justice systems to redirect appropriate candidates from incarceration into evidence-based behavioral health care.

Each participating county begins by passing a formal resolution to reduce the incarceration of individuals with mental illnesses by increasing access to community behavioral health services through a broad, locally-adaptable six-step action plan. These steps include:

• Convening a diverse team of leaders representing jail and mental health services in the county;
• Identifying validated mental health screening tools and a process for screening and assessment;
• Collecting and reviewing the flow of individuals with mental illnesses in and out of jail and behavioral health services;
• Examining community treatment service capacity;
• Developing measurable outcomes; and
• Tracking progress by collecting patient flow data on an ongoing basis.

Counties commit to Stepping Up to implement a plan of action to measure and track progress on four key measures — reduce jail bookings, reduce jail length of stay, increase connections to evidence-based treatment, and reduce recidivism. As part of this process, counties can adapt their own local approaches to facilitate policy changes in pursuit of these goals.

The study, spearheaded by Faye Taxman, Ph.D. , a university professor and director of the Center for Advancing Correctional Excellence at George Mason University and Jennifer Johnson, Ph.D. , C. S. Mott Endowed Professor of Public Health at Michigan State University, takes advantage of a valuable natural experiment — the implementation of the Stepping Up Initiative in 500 counties across 43 states, representing more than 40% of the US population, and 500 comparable counties. Jill Viglione, Ph.D. , assistant professor at the University of Central Florida, is the project director.

The study is designed to identify how Stepping Up participation leads to improved outcomes, and what type of technical assistance has an impact on the progress in meeting key Stepping Up goals. The research team will measure how each county implements the steps of the initiative to determine their effect on the availability and use of evidence-based treatment services by this population.

This study will provide the first empirical evidence of the effectiveness of the widely-implemented Stepping Up Initiative and identify implementation mechanisms that may be used in other criminal justice and mental health quality improvement initiatives. It will also shed light on how best to implement evidence-based practices and procedures in jail and the community to improve the health and well-being of individuals with mental illnesses and substance use problems, reduce or eliminate their episodes of incarceration, and enable them to live stably in the community.

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