Social Determinants of Mental Health Diversion Success: The Influence of Social and Environmental Factors on Program Completion and Post-Program Recidivism
Post-booking mental health jail diversion programs (such as mental health courts) were developed to address the economic, public health, and public safety burdens associated with the overrepresentation of people with mental illness (PMI) in the criminal legal system (Steadman et al., 1994). Despite widespread popularity of post-booking diversion programs, research is equivocal regarding their effectiveness as a means of reducing incarceration and rearrest rates for PMI (Lowder et al., 2018; Sirotich, 2009). A critical problem facing mental health diversion programs is the high rate at which participants drop out prematurely (Hiday et al., 2014; Ray, 2014), which is associated with increased rates of reoffending (Burns et al., 2013; Hiday et al., 2013). Prior diversion research has often focused on clinical or diagnostic factors that impact program retention and recidivism outcomes, and few have yielded consistent findings (Comartin et al., 2015; Seto et al., 2018; Verhaaf & Scott, 2015). Meanwhile, the role of broader social or environmental factors (e.g., housing instability, employment, financial resources) on diversion outcomes has rarely been examined, despite widespread knowledge that such factors are strongly linked to criminal and behavioral health outcomes outside of the diversion literature (Braveman & Gottlieb, 2014; Compton & Shim, 2015).Guided by the social determinants of health (SDOH) framework, the current study investigated the independent and cumulative effects of five social/environmental factors (education, employment, housing, neighborhood risk, financial problems) on program completion and post-discharge recidivism among mental health diversion participants. The study sample consisted of 446 individuals enrolled in post-booking mental health diversion programs in New York City. Of these participants, 181 were monitored for recidivism outcomes during the 6 months following program discharge. Broadly, SDOH factors measured at program intake were found to significantly predict program dropout, with several SDOH factors predicting program dropout even after accounting for demographic, clinical, and treatment variables. Though none of the included SDOH factors significantly predicted post-discharge recidivism, mediation analyses revealed significant indirect effects of SDOH factors on recidivism outcomes via intermediate effects on program completion status. Findings suggest that social and environmental factors have a significant influence on treatment and criminal legal outcomes among PMI in jail diversion programs. Ultimately, results indicate a need for greater attention to the social service needs of mental health diversion participants in order to improve the overall effectiveness of the mental health diversion model.
Feingold, Zoe Rose, "Social Determinants of Mental Health Diversion Success: The Influence of Social and Environmental Factors on Program Completion and Post-Program Recidivism" (2023). ETD Collection for Fordham University. AAI30632106.