Urban Institute
Training and Technical Assistance Manager

Can pay for success help reduce the number of people with mental illnesses in jail?

December 19, 2018 - 4:32pm

According to the Bureau of Justice Statistics, 44 percent of people in jail have a history of mental health disorders [1] and roughly 2 million people with serious mental illnesses are booked into jails across the United States each year. [2] As a result, sheriffs and jail administrators across the country cite jails as the de facto mental health hospitals for their communities as they are often the largest mental health treatment provider in their jurisdictions. Once in jail, many people with mental health disorders or serious mental illnesses receive insufficient treatment, and the time they spend incarcerated can worsen their symptoms and may increase the likelihood of recidivism.  Continuing mental health care post-incarceration for people with serious mental illnesses is a core principle of reentry practices, yet limited reentry resources and services exist to serve this population.

How pay for success could help fill the gap

Pay for success (PFS) has the potential to finance projects that address service gaps and provide care to vulnerable populations, including people in need of mental health treatment after release from jail.  Though some existing PFS projects serve people involved in the criminal justice system, none directly serve this population. Current projects primarily strive to reduce recidivism and/or incarceration in jail, such as Ventura County, California’s Project to Support Reentry and Salt Lake County, Utah’s Recovery, Engagement, Assessment, Career, and Housing program.

Additionally, several PFS projects, including the Denver Social impact Bond Program and the Los Angeles County Just In Reach Project, develop permanent supportive housing for people released from jail. Though connecting formerly incarcerated people with mental health services is a component of the intervention, it is not the primary focus of the projects. 

In December 2016, Santa Clara County, California became the first site to launch a mental health-focused PFS project aimed at providing behavioral health services to 250 people with serious mental illnesses. While an outcome payment for this intervention is the reduction of days spent in jail, it is one of several outcomes used to trigger payments, and eligibility for the program does not include prior incarceration.

A few key components make PFS a good fit to serve this target population.

  • The prevalence of people with mental health disorders and serious mental illness in jails.
  • The beneficial outcomes associated with reducing their time spent in jail and connecting them to treatment in the community.
  • An existing understanding of the evidence-based services beneficial to this population, and the fact that many jurisdictions do not have the resources to fund them or bring them to scale.

A project focused on previously incarcerated people with mental health disorders and serious mental illnesses would require services to be tailored to their specific needs. These might include a direct transfer of care from jail to the service provider to ensure the person is connected to treatment. Investor capital could fund these services and help ensure that people receive the care they need and the opportunity to realize better outcomes.

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As an organization, the Urban Institute does not take positions on issues. Scholars are independent and empowered to share their evidence-based views and recommendations shaped by research. Photo via ShutterStock.

[1] This blog post employs terminology about mental health disorders and mental illnesses used by the American Psychiatric Association (from the DSM-V), the Bureau of Justice Statistics, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

[2] "Booking" refers to a person being processed into jail.